On December 6, 2022, Gov. Scott announced that the State of Vermont has contracted with The Hartford to create the Vermont Family and Medical Leave Insurance Plan (VT-FMLI). Like the New Hampshire paid family and medical leave (PFML), only state employees are required to participate in VT-FMLI, and their benefits will start in July 2023. Private and non-state public employers with 10 or more employees who work an average of 30 hours/week may choose to participate in VT-FMLI’s parental leave program. Private and non-state public employers with 15 or more employees may opt into VT-FMLI’s family leave program beginning in 2024. On July 1, 2025, the program will expand to allow eligible individual employees, including self-employed Vermonters, to purchase from the VT-FMLI individual purchasing pool.

Below are the key highlights of VT-FMLI:

Timeline

• July 1, 2023: Benefits begin for the State of Vermont employees
• July 1, 2024: Private and non-state public employers may start voluntary participation
• July 1, 2025: Individual employees can begin purchasing VT-FMLI

Covered Employers and Individuals

• State of Vermont: Mandatory
• Private and non-state public employers (10+ employees for parental leave, 15+ employees for family leave): Voluntary
• Individual employees, including self-employed in Vermont (excluding the state employees): Voluntary

Eligibility to Take Leave

An employee who has worked for a covered employer an average of 30 hours per week for a year.

Qualified Reasons for Leave

1. Parental Leave
   Parental leave can be taken during the pregnancy and/or after childbirth or within a year following the initial placement of a child 16 years of age or younger with the employee for the purpose of adoption.

2. Family Leave
   Family leave can be taken for the serious illness of the worker, worker’s child, stepchild, ward, foster child, party to a civil union, parent, spouse, or parent of the worker’s spouse.

3. Short-Term Family Leave
   The qualifying reasons for short-term family leave include participating in preschool or school activities related to the academic advancement of the worker’s child, stepchild, foster child or ward who lives with the worker. (For the full descriptions, please refer to the VT-FMLI Fact Sheet.)

Maximum Benefits Duration

Six weeks in a 12-month period.

(The VT-FMLI plans other than for the State of Vermont may be longer than the above duration. Details of the plan offerings have not yet been determined.)

Maximum Benefits Amount

60% of the employee’s average weekly wages (capped at the Social Security Base Benefit Limit).

(The VT-FMLI plans other than for the State of Vermont may provide more benefits than the above percentage. Details of the plan offerings have not yet been determined.)

Press Release »
Fact Sheet »

Gov. Scott recently signed H 266 into law, which requires group health insurance policies issued on or after January 1, 2024, to provide coverage for hearing aids. Each group policy will be required to cover the cost of a medically necessary hearing aid for each ear and the associated hearing aid professional services when the hearing aid or aids are prescribed, fitted, and dispensed by a hearing care professional. The coverage shall include hearing aid batteries when prescribed by a hearing care professional. Coverage may be limited to one hearing aid per ear every three years. The coverage may be subject to the plan’s normal cost-sharing requirements (deductible, copayment and coinsurance).

Further, the Departments of Vermont Health Access and of Financial Regulation intend to modify the essential health benefits in Vermont's benchmark plan to include coverage of hearing aids and related services beginning in plan year 2024. This means that self-insured employer plans which have chosen Vermont as their benchmark plan would be required to provide such coverage for plan years beginning in 2024.

There is no action required of employers now. However, when the law becomes effective, employer plan sponsors will need to work with their insurer or administrative services only carrier to modify coverage, if necessary.

H 266 »

Vermont’s crime victim leave law requires employers to provide unpaid job protected leave for eligible employees to attend a deposition or court processing related to a criminal processing when an employee is an alleged victim. Employees who have been continuously employed for at least six months for an average of at least 20 hours per week and who are the victims of crimes are eligible to take the leave. The eligible employees are allowed to use accrued sick, vacation, and other paid time off leave during the crime victim leave.

Additionally, employers with Vermont employee(s) are required to post a written notice regarding an employee’s right to crime victim leave. The Crime Victims Rights poster can be retrieved from the following state’s site, Vermont Department of Labor.

The revised legislation (HB 477) expands the current crime victim leave to include relief from stalking or abuse. The term “alleged victim” also includes a family member.

Employers who have an employee(s) in Vermont should be aware of this added new change.

HB 477 »

Gov. Scott recently signed H. 960 into law, which relaxes certain rules related to prescription drug refills due to the COVID-19 emergency.

Through June 30, 2021, a pharmacist may extend a previous prescription for a maintenance medication for which the patient has no refills remaining or for which the authorization for refills has recently expired if it is not feasible to obtain a new prescription or refill authorization from the prescriber.

Through March 31, 2021, a pharmacist may, with the informed consent of the patient, substitute an available drug or insulin product for an unavailable prescribed drug or insulin product in the same therapeutic class if the available drug or insulin product would, in the clinical judgment of the pharmacist, have substantially equivalent therapeutic effect even though it is not a therapeutic equivalent.

Through March 31, 2021, to the extent permitted under federal law, a healthcare professional authorized to prescribe buprenorphine for treatment of substance use disorder may authorize renewal of a patient's existing buprenorphine prescription without requiring an office visit.

The pharmacy benefit manager administering the group’s prescription drug benefits should revise the plan’s procedures to accommodate these changes. Employers should be aware of the changes and discuss any questions with the administrator.

H. 960 »

On July 21, 2020, the Department of Financial Regulation issued Insurance Bulletin No. 214, which clarifies the COVID-19 tests that must be covered without cost sharing. The bulletin provides the procedure codes for the specific tests and also provides the diagnosis codes for the office and hospital charges that should be associated with the testing. This bulletin will remain in effect for 90 days or longer.

While the bulletin provides additional information to insurers that will assist in their billing and administration of health benefits, employers should be aware of this bulletin in the event that participants receive testing.

Insurance Bulletin No. 214 »

On March 25, 2020, the Department of Financial Regulation issued Emergency Rule H-2020-02-E, seeking to expand patients’ access to and providers’ reimbursement of telehealth services. Specifically, the rule requires health insurance plan and carriers to cover telehealth services to the same extent that they would cover them if they were provided in person. Additionally, patient’s must be able to access as many telehealth services as they could in-person services, and the services must be offered at the same cost-sharing levels.

While insurers will have to comply with this guidance, employers should familiarize themselves with the additional telehealth benefits provided.

Emergency Rule H-2020-02-E »

On April 14, 2020, the Department of Financial Regulation issued Emergency Rule H-2020-03-E, to expand health insurance coverage for and waive or limit cost-sharing requirements for COVID-19 diagnosis, treatment and prevention. The rule essentially requires that COVID-19 testing and treatment be provided with no cost sharing.

While insurers will have to comply with this guidance, employers should familiarize themselves with the additional telehealth benefits provided.

Emergency Rule H-2020-03-E »

On March 31, 2020, the Department of Labor provided an FAQ on COVID-19, providing information to employers and employees. While the FAQ mostly focus on employment law questions and the answers to those questions from both the employer and employee standpoint, there is some guidance that are applicable to employer’s plans. Namely, the FAQ remind employers that bill H. 742 states that employer’s experience ratings will not be charged for benefits paid to employees for any of the COVID-19 related reasons. The guidance also discusses the employees’ eligibility for unemployment benefits should they be terminated or placed on leave from their job.

COVID-19 Frequently Asked Questions »

On March 24, 2020, Vermont’s Health Connect announced that they would allow for a special enrollment period for those who do not currently have health insurance to enroll in a qualified health plan and receive premium and cost-sharing assistance.

Although employers do not have any compliance obligations related to this announcement, they may have employees that can access the coverage should they be terminated or lose health coverage.

Vermont Health Connect »

On March 20, 2020, Commissioner Pieciak issued Bulletin No. 210, requiring insurers to make various changes that will minimize the need for close contact with others during the COVID-19 pandemic. Specifically, the bulletin directs insurers to allow Vermonters to fill a 30-day supply of their medication. The bulletin also encourages pharmacies to provide fill prescriptions in the same manner and at the same level of reimbursement as mail-order prescriptions. Employers can notify their plan participants of these modified prescription rules.

Bulletin No. 210 »