Vermont § 4030 - Optional standard policy provisions Except as provided in section 4031 of this title, no health insurance policy delivered or issued for delivery to any person in this

§ 4030. Optional standard policy provisions Except as provided in section 4031 of this title, no health insurance policy delivered or issued for delivery to any person in this

• State shall contain provisions respecting the matters set forth in this section unless
  the provisions use the language set forth in this section; provided, however, that
  a health insurer may, at its option, substitute different language approved by the
  Commissioner for one or more provisions, provided the substituted language is not
  less favorable in any respect to the insured or covered individual than the language
  used in this section. Any provision set forth in this section that is contained in
  the policy shall be preceded individually by the appropriate caption appearing in
  this section or, at the option of the health insurer, by such appropriate captions
  or subcaptions as the Commissioner may approve: (1) CHANGE OF OCCUPATION: If the insured be injured or contract sickness after having
  changed his or her occupation to one classified by the insurer as more hazardous than
  that stated in this policy or while doing for compensation anything pertaining to
  an occupation so classified, the insurer will pay only such portion of the indemnities
  provided in this policy as the premium paid would have purchased at the rates and
  within the limits fixed by the insurer for such more hazardous occupation. If the
  insured changes his or her occupation to one classified by the insurer as less hazardous
  than that stated in this policy, the insurer, upon receipt of proof of such change
  of occupation, will reduce the premium rate accordingly, and will return the excess
  pro rata unearned premium from the date of change of occupation or from the policy
  anniversary date immediately preceding receipt of such proof, whichever is the more
  recent. In applying this provision, the classification of occupational risk and the
  premium rates shall be such as have been last filed by the insurer prior to the occurrence
  of the loss for which the insurer is liable or prior to date of proof of change in
  occupation with the state official having supervision of insurance in the state where
  the insured resided at the time this policy was issued; but if such filing was not
  required, then the classification of occupational risk and the premium rates shall
  be those last made effective by the insurer in such state prior to the occurrence
  of the loss or prior to the date of proof of change in occupation. (2) MISSTATEMENT OF AGE: If the age of the insured has been misstated, all amounts payable
  under this policy shall be such as the premium paid would have purchased at the correct
  age. (3) OTHER INSURANCE IN THIS INSURER: If an accident or sickness or accident and sickness
  policy or policies previously issued by the insurer to the insured be in force concurrently
  herewith, making the aggregate indemnity for .... (insert type of coverage or coverages)
  in excess of $.................... (insert maximum limit of indemnity or indemnities)
  the excess insurance shall be void and all premiums paid for such excess shall be
  returned to the insured or to his or her estate. or, in lieu thereof: Insurance effective at any one time on the insured under a like policy or policies
  in this insurer is limited to the one such policy elected by the insured, his or her
  beneficiary or his or her estate, as the case may be, and the insurer will return
  all premiums paid for all other such policies. (4) INSURANCE WITH OTHER INSURERS: If there be other valid coverage, not with this insurer,
  providing benefits for the same loss on a provision of service basis or on an expense
  incurred basis and of which this insurer has not been given written notice prior to
  the occurrence or commencement of loss, the only liability under any expense incurred
  coverage of this policy shall be for such proportion of the loss as the amount which
  would otherwise have been payable hereunder plus the total of the like amounts under
  all such other valid coverages for the same loss of which this insurer had notice
  bears to the total like amounts under all valid coverages for such loss, and for the
  return of such portion of the premiums paid as shall exceed the pro rata portion for
  the amount so determined. For the purpose of applying this provision when other coverage
  is on a provision of service basis, the “like amount” of such other coverage shall
  be taken as the amount which the services rendered would have cost in the absence
  of such coverage. (If the foregoing policy provision is included in a policy which also contains the next following policy provision there shall be added to the caption of the foregoing provision the phrase “—EXPENSE INCURRED BENEFITS.” The insurer may, at its option, include in this provision a definition of “other valid coverage,” approved as to form by the Commissioner, which definition shall be limited in subject matter to coverage provided by organizations subject to regulation by insurance law or by insurance authorities of this or any other state of the United States or any province of Canada, and by hospital or medical service organizations, and to any other coverage the inclusion of which may be approved by the Commissioner. In the absence of such definition such term shall not include group insurance, automobile medical payments insurance, or coverage provided by hospital or medical service organizations or by union welfare plans or employer or employee benefit organizations. For the purpose of applying the foregoing policy provision with respect to any insured, any amount of benefit provided for such insured pursuant to any compulsory benefit statute (including any workers’ compensation or employer’s liability statute) whether provided by a governmental agency or otherwise shall in all cases be deemed to be “other valid coverage” of which the insurer has had notice. In applying the foregoing policy provision no third party liability coverage shall be included as “other valid coverage.”) (5) INSURANCE WITH OTHER INSURERS: If there be other valid coverage, not with this insurer,
  providing benefits for the same loss on other than an expense incurred basis and of
  which this insurer has not been given written notice prior to the occurrence or commencement
  of loss, the only liability for such benefits under this policy shall be for such
  proportion of the indemnities otherwise provided hereunder for such loss as the like
  indemnities of which the insurer had notice (including the indemnities under this
  policy) bear to the total amount of all like indemnities for such loss, and for the
  return of such portion of the premium paid as shall exceed the pro rata portion for
  the indemnities thus determined. (If the foregoing policy provision is included in a policy which also contains the next preceding policy provision there shall be added to the caption of the foregoing provision the phrase “—OTHER BENEFITS.” The insurer may, at its option, include in this provision a definition of “other valid coverage,” approved as to form by the Commissioner, which definition shall be limited in subject matter to coverage provided by organizations subject to regulation by insurance law or by insurance authorities of this or any other state of the United States or any province of Canada, and to any other coverage the inclusion of which may be approved by the Commissioner. In the absence of such definition such term shall not include group insurance, or benefits provided by union welfare plans or by employer or employee benefit organizations. For the purpose of applying the foregoing policy provision with respect to any insured, any amount of benefit provided for such insured pursuant to any compulsory benefit statute (including any workers’ compensation or employer’s liability statute) whether provided by a governmental agency or otherwise shall in all cases be deemed to be “other valid coverage” of which the insurer has had notice. In applying the foregoing policy provision no third party liability coverage shall be included as “other valid coverage.”) (6) RELATION OF EARNINGS TO INSURANCE: If the total monthly amount of loss of time benefits
  promised for the same loss under all valid loss of time coverage upon the insured,
  whether payable on a weekly or monthly basis, shall exceed the monthly earnings of
  the insured at the time disability commenced or his or her average monthly earnings
  for the period of two years immediately preceding a disability for which claim is
  made, whichever is the greater, the insurer will be liable only for such proportionate
  amount of such benefits under this policy as the amount of such monthly earnings or
  such average monthly earnings of the insured bears to the total amount of monthly
  benefits for the same loss under all such coverage upon the insured at the time such
  disability commences and for the return of such part of the premiums paid during such
  two years as shall exceed the pro rata amount of the premiums for the benefits actually
  paid hereunder; but this shall not operate to reduce the total monthly amount of benefits
  payable under all such coverage upon the insured below the sum of $200.00 or the sum
  of the monthly benefits specified in such coverages, whichever is the lesser, nor
  shall it operate to reduce benefits other than those payable for loss of time. (The foregoing policy provision may be inserted only in a policy which the insured
  has the right to continue in force subject to its terms by the timely payment of premiums
  (1) until at least age 50; or (2) in the case of a policy issued after age 44, for
  at least five years from its date of issue. The insurer may, at its option, include
  in this provision a definition of “valid loss of time coverage,” approved as to form
  by the Commissioner, which definition shall be limited in subject matter to coverage
  provided by governmental agencies or by organizations subject to regulation by insurance
  law or by insurance authorities of this or any other state of the United States or
  any province of Canada, or to any other coverage the inclusion of which may be approved
  by the Commissioner or any combination of such coverages. In the absence of such definition
  such term shall not include any coverage provided for such insured pursuant to any
  compulsory benefit statute (including any workers’ compensation or employer’s liability
  statute), or benefits provided by union welfare plans or by employer or employee benefit
  organizations.) (7) UNPAID PREMIUM: Upon the payment of a claim under this policy, any premium then due
  and unpaid or covered by any note or written order may be deducted therefrom. (8) CANCELLATION: The insurer may cancel this policy at any time by written notice delivered
  to the insured, or mailed to his or her last address as shown by the records of the
  insurer, stating when, not less than five days thereafter, such cancellation shall
  be effective; and after the policy has been continued beyond its original term the
  insured may cancel this policy at any time by written notice delivered or mailed to
  the insurer, effective upon receipt or on such later date as may be specified in such
  notice. In the event of cancellation, the insurer will return promptly the unearned
  portion of any premium paid. If the insured cancels, the earned premium shall be computed
  by the use of the short-rate table last filed with the state official having supervision
  of insurance in the state where the insured resided when the policy was issued. If
  the insurer cancels, the earned premium shall be computed pro rata. Cancellation shall
  be without prejudice to any claim originating prior to the effective date of cancellation. (9) CONFORMITY WITH STATE STATUTES: Any provision of this policy which, on its effective
  date, is in conflict with the statutes of the state in which the insured resides on
  such date is hereby amended to conform to the minimum requirements of such statutes. (10) ILLEGAL OCCUPATION: The insurer shall not be liable for any loss to which a contributing
  cause was the insured’s commission of or attempt to commit a felony or to which a
  contributing cause was the insured’s being engaged in an illegal occupation. (Recodified and amended 2025, No. 11, § 2, eff. September 1, 2025.)