§ 4058.
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§ 4058. Medical support orders
(a)As used in this section:
(1)“Dependent coverage” means family coverage, or coverage for one or more persons as long as the coverage for one or more persons is greater than or equal to the coverage available under family coverage.
(2)“Health insurance plan” has the same meaning as in section 4011 of this chapter and shall be subject to the same excepted benefits, in each case, as set forth in 45 C.F.R. § 146.145, as in effect as of December 31, 2017.
(b)A health insurer shall not deny enrollment of a child under the health insurance plan of the child’s parent who is ordered to provide medical support on the grounds that:
(1)the child was born to unmarried parents;
(2)the child is not claimed as a dependent on the parent’s federal tax return; or
(3)the child does not reside with the parent or in the health insurer’s service area.
(c)When a parent is required by a court or administrative order to provide health coverage for a child, and the parent is eligible for dependent health coverage, the health insurer shall be required:
(1)To enroll, under the dependent coverage, a child who is otherwise eligible for the coverage without regard to any enrollment season restrictions or any seasonal restrictions on switching from one plan to another, upon application of either parent, the employer, the State agency administering the Medicaid program, any State agency administering health benefits or a health insurance plan for which Medicaid is a source of funding, or the child support enforcement program.
(2)Not to disenroll or eliminate coverage of the child unless the health insurer is provided satisfactory written evidence that:
(A)the court or administrative order is no longer in effect;
(B)the child is or will be enrolled in comparable health coverage through another health insurer that will take effect not later than the effective date of disenrollment; or
(C)the employer has eliminated dependent health coverage for all of its employees if allowed by law.
(3)To provide enrollment under subdivision
(1)of this subsection with coverage effective three days after the mailing of notice of the court or administrative order to the health insurer or upon actual receipt of notice by the health insurer, whichever is sooner. The health insurer shall have 10 days from notice to process the enrollment and shall be entitled to premiums from the effective date of enrollment.
(d)A health insurer shall not impose requirements on a State agency that has been assigned the rights of an individual eligible for medical assistance under Medicaid and covered for health benefits from the health insurer that are different from requirements applicable to an agent or assignee of any other individual so covered.
(e)Any health insurer that fails to enroll a child after notice under 15 V.S.A. § 663(d) or 33 V.S.A. § 4110(a)(4) shall be directly liable for any medical expenses of the child that would have been covered under the health insurance plan had the health insurer enrolled the child upon receiving notice.
(f)Notice by first-class mail, postage prepaid, or by any other method showing actual receipt shall be presumptive evidence of its receipt by the health insurer to whom it is addressed. Any period of time that is determined under this section by the giving of notice shall commence to run from the date of mailing, if the notice is mailed, or the date of actual receipt if another method of transmitting the notice is used.
(g)A health insurer may cancel any health insurance plan that is the subject of a medical support order for nonpayment of premium only if the health insurer mails or delivers notice of cancellation to both parents and all other persons or agencies identified in the medical support order. Any health insurer cancelling a health insurance plan for nonpayment of premium shall reinstate the health insurance plan effective from the date of cancellation if the nonpayment of premium is cured within 45 days of the cancellation. (Recodified and amended 2025, No. 11, § 2, eff. September 1, 2025.)