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S.285

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

It is hereby enacted by the General Assembly of the State of Vermont:

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

§ 4089d.  COVERAGE; DEPENDENT CHILDREN

(a)  Any group or individual policy of health insurance or, any subscriber contract of a nonprofit hospital or medical service corporation, any self-insured group plan, and any 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 provides that coverage of a dependent child shall terminate upon attainment of the limiting age for dependent children specified in the policy,:

(1)  shall not limit or restrict coverage with respect to an unmarried child who is incapable of self-sustaining employment by reason of mental retardation, cerebral palsy, epilepsy or physical handicap 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 and who became so incapable prior to attainment of the limiting age and who is chiefly dependent upon the employee or, member, subscriber, or policyholder for support and maintenance; and

(2)  if the policy or health plan 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 subdivision (1) of this subsection as appropriate.  To establish entitlement to coverage under this subdivision, 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. 

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

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.

Sec. 3.  VHAP ELIGIBILITY RULES

The secretary of human services shall adopt or amend regulations to ensure, to the extent permitted under federal law, that a college student taking medical leave who applies for VHAP or another Medicaid waiver program has his or her eligibility determined on the basis of the student's income only, and not the parent's income, even if the student receives room and board from his or her parents.  If necessary, the agency shall seek an amendment to the Global Commitment to Health Medicaid waiver to modify eligibility for this group.  The secretary shall also clarify all regulations concerning VHAP eligibility for college students, either through amended regulations or issuance of interpretive bulletins. 

 



Published by:

The Vermont General Assembly
115 State Street
Montpelier, Vermont


www.leg.state.vt.us