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BILL AS PASSED BY SENATE 2007-2008

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S.39

AN ACT RELATING TO HEALTH INSURANCE PLAN REIMBURSEMENT FOR COVERED SERVICES PROVIDED BY NATUROPATHIC PHYSICIANS

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

Sec. 1.  8 V.S.A. § 4088d is added to read:

§ 4088d.  COVERAGE FOR COVERED SERVICES PROVIDED BY

                 NATUROPATHIC PHYSICIANS

(a)  A health insurance plan shall provide coverage for medically necessary health care services covered by the plan when provided by a naturopathic physician licensed in this state for treatment within the scope of practice described in chapter 81 of Title 26.  Health care services provided by naturopathic physicians may be subject to reasonable deductibles, co-payment and co-insurance amounts, fee or benefit limits, practice parameters, and utilization review consistent with any applicable regulations published by the department of banking, insurance, securities, and health care administration; provided that any such amounts, limits, and review shall not function to direct treatment in a manner unfairly discriminative against naturopathic care, and collectively shall be no more restrictive than those applicable under the same policy to care or services provided by other health care providers, but allowing for the management of the benefit consistent with variations in practice patterns and treatment modalities among different types of health care providers.  Nothing contained herein shall be construed as impeding or preventing either the provision or the coverage of health care services by licensed naturopathic physicians, within the lawful scope of naturopathic practice, in hospital facilities on a staff or employee basis.

(b)  As used in this section, “health insurance plan” means any individual or group health insurance policy, any hospital or medical service corporation or health maintenance organization subscriber contract, or any other health benefit plan offered, issued, or renewed for any person in this state by a health insurer, as defined by 18 V.S.A. § 9402.  The term shall not include benefit plans providing coverage for specific disease or other limited benefit coverage.

Sec. 2.  8 V.S.A. chapter 107, subchapter 10 is added to read:

Subchapter 10.  Prostate Screenings

§ 4100f.  PROSTATE SCREENINGS; COVERAGE REQUIRED

(a)  Health insurers shall provide coverage for prostate cancer screenings.  Benefits provided shall be at least as favorable as coverage for other cancer screening procedures and subject to the same dollar limits, deductibles, and coinsurance factors within the provisions of the policy.

(b)  Coverage shall be provided for screenings at intervals consistent with the recommendations by the Centers for Disease Control or upon recommendation of a health care provider.

(c)  For purposes of this section, “health insurer” is defined by subdivision 9402(9) of Title 18.  The term does not apply to coverage for specified disease or other limited benefit coverage.



Published by:

The Vermont General Assembly
115 State Street
Montpelier, Vermont


www.leg.state.vt.us