Public Act No. 176 - Coverage/Benefits for the Care and Treatment of Alcohol Dependency

ORIGINAL

STATE OF VERMONT

DEPARTMENT OF BANKING AND INSURANCE

MONTPELIER 05602

TEL. 802-828-3301

DIVISIONS OF:

BANKING

INSURANCE

SECURITIES

BULLETIN #60

JULY 12, 1982

PUBLIC ACT NO. 176 - COVERAGE/BENEFITS FOR THE

CARE AND TREATMENT OF ALCOHOL DEPENDENCY

(SUBCHAPTER 6. ALCOHOLISM; 8 V.S.A., CHAPTER 107)

Effective July 1, 1982, insurers, non-profit hospital

and medical service plan corporations, and health maintenance

organizations transacting health insurance in Vermont are

required to offer, as an option, coverage/benefits for the

necessary care and treatment of alcohol dependency under

group health insurance policies, and contract plans; in

accordance with Public Act No. 176, 1981 Adj. Session,

House Bill No. 280, (8 V.S.A., §§4097-4100).

Since October 1, 1976, 8 V.S.A., §4089 (Mental Illness),

has required that insurers, et al. issuing group health

insurance policies, contracts, etc. provide, as an option,

coverage/benefits for the care and active treatment of any

mental condition or disorder falling under any of the

diagnostic categories listed in the mental disorders

section of the International Classification of Diseases

(ICD-9-CM). Among the disorders included therein are

substance abuse and substance dependence, which include

alcoholism and alcohol dependency, as well as other

substance abuse and dependency.

This Department's review of 8 V.S.A., §4089 and

§§4097-4100 clearly reveals certain conflicts and overlap

which may result in, at best, an unsuitable or ambiguous

contract, if disparate policy endorsements are issued under

the same group health insurance contract. Accordingly,

this Department is in the process of finalizing a regulation

addressing the minimum requirements for both the general

mental health option and the specific alcoholism option,

and minimum guidelines for the creation of a single

combination endorsement.

The purposes of this bulletin are:

ntract, if disparate policy endorsements are issued under

the same group health insurance contract. Accordingly,

this Department is in the process of finalizing a regulation

addressing the minimum requirements for both the general

mental health option and the specific alcoholism option,

and minimum guidelines for the creation of a single

combination endorsement.

The purposes of this bulletin are:

1) To inform all affected insurers, et al. of this

Department's contemplated actions in addressing

these statutory ambiguities, and

2) To suggest that such insurers, et al. may find

it advisable to inform their group health contract

holders, when the optional alcoholism coverage/

benefits are being offered, pursuant to 8 V.S.A.,

§§4097-4100, that if their present group policy,

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contract or plan affords mental illness benefits,

it may duplicate or conflict with provisions of

the specific alcoholism option. Insurers, et al.

should also examine whether or not an unsuitable

policy or contract will result.

This Department is also conferring with the State of

Vermont Agency of Human Services to clarify or expand, by

regulation pursuant to 8 V.S.A., §4089(d), those health

care facilities that may be qualified to render substance

abuse and dependency treatment services. Currently,

several alcohol/substance dependency treatment facilities

exist in Vermont which are not licensed or qualified as

a general hospital, public or licensed mental hospital or

a community mental health center, and consequently, can

not be utilized and reimbursed under a group policy or

contract issued in accordance with the prevailing provisions

of §4089 of 8 V.S.A.; but are so recognized and can be

utilized under the provisions of §§4097-4100 of 8V.S.A.

ies

exist in Vermont which are not licensed or qualified as

a general hospital, public or licensed mental hospital or

a community mental health center, and consequently, can

not be utilized and reimbursed under a group policy or

contract issued in accordance with the prevailing provisions

of §4089 of 8 V.S.A.; but are so recognized and can be

utilized under the provisions of §§4097-4100 of 8V.S.A.

The specific regulation forthcoming from this Department

will address all of the outstanding questions and concerns

brought about by the aforementioned statutes. However,

in the interim, our contemplated actions should not allow

an individual insurer to delay the development of a single

(combination) endorsement/order designed to reconcile

these statutory conflicts.

GEORGE A. CHAFFEE

COMMISSIONER OF BANKING & INSURANCE