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S.285

AN ACT RELATING TO COVERAGE OF DISABLED ADULT CHILDREN AND COLLEGE STUDENTS ON MEDICAL LEAVE

The House proposes to the Senate to amend the bill by striking all after the enacting clause and inserting in lieu thereof the following:

Sec. 1.  8 V.S.A. § 4089d is amended to read:

§ 4089d.  COVERAGE; DEPENDENT CHILDREN

(a)  Any As used in this section, “health insurance plan” shall mean any group or individual policy of health insurance or any subscriber contract of a, nonprofit hospital or medical service corporation, subscriber contract, health maintenance organization contract, self-insured group plan, and prepaid health insurance plans delivered, issued for delivery, renewed, replaced, or assumed by another insurer, or in any other way continued in force in this state which.

(b)  A health insurance plan that provides that for terminating the coverage of a dependent child shall terminate upon attainment of the limiting age for dependent children specified in the policy, shall not limit or restrict coverage with respect to an unmarried child who:

(1)  is incapable of self-sustaining employment by reason of mental retardation, cerebral palsy, epilepsy or physical handicap a mental or physical disability that has been found to be a disability that qualifies or would qualify the child for benefits using the definitions, standards, and methodology in 20 C.F.R. Part 404, Subpart P;

(2)  and who became so incapable prior to attainment of the limiting age;  and

(3)  who is chiefly dependent upon the employee or, member, subscriber, or policyholder for support and maintenance

(c)  Coverage under any policy or contract subject to subsection (b) of this section shall not be denied any person based upon the existence of such a condition; however an insurer a health insurance plan may require reasonable periodic proof of a continuing condition no more frequently than once every year.

(d)  A health insurance plan that covers dependent children who are full‑time college students beyond the age of 18 shall include coverage for a dependent’s medically necessary leave of absence from school for a period not to exceed 24 months or the date on which coverage would otherwise end pursuant to the terms and conditions of the policy or coverage, whichever comes first, except that coverage may continue under subsection (b) of this section as appropriate.  To establish entitlement to coverage under this subsection, documentation and certification by the student’s treating physician of the medical necessity of a leave of absence shall be submitted to the insurer or, for self-insured plans, the health plan administrator.  The health insurance plan may require reasonable periodic proof from the student’s treating physician that the leave of absence continues to be medically necessary.

Sec. 2.  STUDY ON CONTINUATION COVERAGE FOR YOUNG ADULT

             CHILDREN AND SPOUSES FOLLOWING DIVORCE OR

             DISSOLUTION

(a)  A committee is established to study issues related to continuing health insurance eligibility for spouses following divorce or dissolution of a civil union and for young adult children.  

(b)  The committee shall consist of the following members:

(1)  the commissioner of banking, insurance, securities, and health care administration or designee;

(2)  a Vermont attorney who practices family law appointed by the Vermont bar association; 

(3)  the state health care ombudsman;

(4)  the executive director of the Vermont commission on women or designee; and

(5)  an individual representing each of the following, to be appointed by the commissioner of banking, insurance, securities, and health care administration:

(A)  private health insurance companies insuring Vermonters;

(B)  Vermont employers; and

(C)  youth service organizations.

(c)  The committee shall study:

(1)  whether and how health insurance coverage should be provided to a former spouse or civil union partner under the insurance policy or health plan coverage under which he or she was covered before the divorce or civil union dissolution; and

(2)  whether and how health insurance coverage should be provided to a young adult child under the insurance policy or health plan coverage of his or her parent and under which he or she was covered before attaining the limiting age for dependent children specified in the policy.

(d)  The committee shall consider:

(1)  the number of potentially eligible young adults and former spouses and the need for coverage for these populations;

(2)  which insurance markets and state-regulated, self-insured health plans, if any, should be required to provide continued coverage;

(3)  whether such coverage should be provided in all plans, by option, by rider, or in some other manner;

(4)  standards for eligibility for and termination of such coverage;

(5)  any potential impact on employers;

(6)  any potential impact on the cost of coverage under the health insurance policy or health benefit plan;

(7)  privacy issues;

(8)  income tax issues; and

(9)  in relation to post-divorce and -dissolution coverage:

(A)  issues relating to family court actions; and

(B)  the impact of subsequent remarriage or civil union of either party.

(e)  The representative of the department of banking, insurance, securities, and health care administration shall serve as chair of the committee. 

(f)  The committee shall have the assistance and cooperation of the department of banking, insurance, securities, and health care administration, which shall provide professional and administrative support for the committee, the Vermont state employees’ association, and the department of human resources. 

(g)  The committee shall report its findings and recommendations, including proposals for legislative action, to the general assembly and the governor no later than January 15, 2007, whereupon it shall cease to exist.

 



Published by:

The Vermont General Assembly
115 State Street
Montpelier, Vermont


www.leg.state.vt.us