§ 4069.
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/vt/title-8/chapter-107/4069A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
§ 4069. Prosthetic devices
(a)As used in this section, “prosthetic device” means an artificial limb device to replace, in whole or in part, an arm or a leg.
(b)A health insurance plan shall provide coverage for prosthetic devices that is at least equivalent to the coverage provided by the federal Medicare program. Coverage may be limited to the prosthetic device that is the most appropriate model that is medically necessary to meet the patient’s medical needs. Any dispute between the covered individual and the carrier concerning coverage and the application of this section shall be subject to independent external review under section 4063 of this title.
(c)A health insurance plan may require prior authorization for prosthetic devices in the same manner and to the same extent as prior authorization is required for any other covered benefit.
(d)A health insurance plan shall provide coverage under this section for the medically necessary repair or replacement of a prosthetic device.
(e)The coverage for prosthetic devices shall not be subject to a deductible, co-payment, or coinsurance provision that is less favorable to a covered individual than the deductible, co-payment, or coinsurance provisions that apply generally to other nonprimary care items and services under the health insurance plan. (Recodified and amended 2025, No. 11, § 2, eff. September 1, 2025.)