Coverage for Pregnancy and Pregnancy-Related Conditions

STATE OF VERMONT

DEPARTMENT OF BANKING AND INSURANCE

MONTPELIER 05602

TEL. 802-828-3301

ORIGINAL

DIVISIONS OF:

BANKING

INSURANCE

SECURITIES

BULLETIN NO. 54 (Revised)

April 22, 1981

RE: COVERAGE FOR PREGNANCY AND PREGNANCY-RELATED CONDITIONS:

EMPLOYER-PROVIDED HEALTH BENEFITS

The Vermont Attorney General has interpreted 21 V.S.A. § 495

to require that any employer-provided health benefits plan must

include benefits for pregnancy and pregnancy-related conditions.

This interpretation is in keeping with the directives of

Public Law 95-555 (the so-called "Pregnancy Discrimination Act

of 1978"), which requires an employer of fifteen or more employees

to include coverage for pregnancy in any health benefits plan

made available in connection with employment, on the same basis

as other medical conditions.

The Attorney General has similarly interpreted 21 V.S.A.

§ 495 to require the same treatment of employer-provided benefits

as that directed by Public Law 95-555. Vermont law, as it is

interpreted, therefore requires that if health benefits are made

available by an employer, those benefits must include provision

for pregnancy and pregnancy-related conditions. This applies

regardless of who funds the benefits (or who pays the premiums),

and irrespective of the number of employees.

Accordingly, please be advised that this office expects all

insurers doing business in this state to advise its employer/

insureds, when appropriate, as to the requirements of both

federal and state law in this area, if they have not already

done so.

nancy-related conditions. This applies

regardless of who funds the benefits (or who pays the premiums),

and irrespective of the number of employees.

Accordingly, please be advised that this office expects all

insurers doing business in this state to advise its employer/

insureds, when appropriate, as to the requirements of both

federal and state law in this area, if they have not already

done so.

Clearly it is the employer who must comply with these

requirements and not the insurer. However, in the context of

a sale of an insurance policy covering employee benefits, if

an insurer should erroneously advise its employer/insured as

to the above-described required benefit, and the employer/

insured relies on that incorrect advice and purchases an insurance plan on that basis, it may be grounds for this office to

treat this as a sale of an "unsuitable policy" within the meaning

of 8 V.S.A. § 4724(16) or as "unfair discrimination" within the

meaning of 8 V.S.A. § 4724(7)(A).

George A. Chaffee

Commissioner