Vermont Statutes Title 8 Sec. 4096
Terms Used In Vermont Statutes Title 8 Sec. 4096
- Contract: A legal written agreement that becomes binding when signed.
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- Home health agency: means a nonprofit home health agency which has been certified under Title 18 of the Social Security Act (42 U. See
- Home health care: means care and treatment provided by a home health agency and designed and supervised by a physician, without which care and treatment a person would require institutionalization in a hospital or skilled nursing facility as those are defined by Medicare regulations. See
- Person: shall include any natural person, corporation, municipality, the State of Vermont or any department, agency, or subdivision of the State, and any partnership, unincorporated association, or other legal entity. See
§ 4096. Home health care; insurance
(a) An individual or group health insurance expense policy and an individual or group service contract issued by a nonprofit hospital corporation which provides hospital or medical coverage shall provide as an option coverage for home health care. An insurer may require evidence of insurability as a prerequisite to coverage. The coverage shall consist of at least 40 visits by a home health agency in any calendar year, or in any continuous period of 12 months, for each person covered under the policy or contract. Each visit by a member of a home health care agency, other than a home health aide, shall be considered one home health care visit, and four hours of home health aide service shall be considered one home health care visit. Coverage shall be provided for maternity and childbirth, but such coverage may be provided subject to a waiting period of nine months.
(b) This subchapter does not require that home health care coverage be provided to persons eligible for Medicare, nor does it require that the coverage be included in indemnity policies or contracts.
(c) Home health care coverage may be subject to a co-insurance provision of not less than 80 percent of reasonable charges and a deductible provision of $50.00 annually; however, if less restrictive benefits are provided by the basic hospital or medical coverage, as the case may be, these lesser restrictions shall apply to the home health care coverage.
(d) A benefit provided pursuant to this subchapter may be subject to utilization review by the nonprofit hospital service corporation. A nonprofit hospital service corporation may require a home health agency to enter into a contract as a condition of providing benefits. (Added 1975, No. 205 (Adj. Sess.), § 1.)