Employers have no obligation under Vermont law to offer long-term care insurance to their employees. However, if long-term care insurance is among the benefits offered, certain state law requirements limit how the plan may be designed.
A long-term care policy cannot define a “preexisting condition” more restrictively than as a condition for which medical advice or treatment was recommended by or received from a provider of healthcare services within six months before the effective date of coverage. Additionally, no long-term care insurance policy or certificate may exclude coverage for a loss or confinement that is the result of a preexisting condition, unless such loss or confinement begins within six months following the effective date of coverage (8 V.S.A. Sec. 8086).
A long-term care insurance policy may not limit or exclude coverage by type of illness, treatment, medical condition, or accident, except for:
• Preexisting conditions and diseases;
• Illness, treatment, or medical condition arising out of war or act of war (whether declared or undeclared); participation in a felony, riot, or insurrection; service in the armed forces or auxiliary units; attempted suicide (while sane) or an intentional self-inflicted injury (while sane); or aviation for non-fare-paying passengers;
• Treatment provided in a government facility (unless required by law);
• Services for which benefits are available under Medicare or other governmental program (except Medicaid); any state or federal workers' compensation, employer's liability, or occupational disease law; or any motor vehicle no-fault law;
• Services provided by a member of the covered person's ...