DFR Launches Campaign to Help Vermonters Understand Their Health Insurance Coverage and Rights for Reproductive Health Services

MONTPELIER - The Vermont Department of Financial Regulation (DFR) is launching a new campaign aimed at helping Vermonters better understand state and federal laws requiring health insurance coverage of reproductive, preventive, and telehealth services and how to file complaints for incorrect coverage.

The campaign and new webpage provide clear, actionable information for Vermonters with state-regulated commercial health insurance about services that are required to be covered by state and federal laws, often at low or no cost. These include preventive and contraceptive services, including a 12-month supply of prescription birth control, other FDA-approved contraceptives, and related services such as counseling, procedures, and follow-up visits.

The campaign highlights state laws requiring insurers to cover telehealth services at the same level as in-person care. Telehealth may be a helpful option for Vermonters who face transportation challenges or live in rural areas with few providers. The campaign also informs Vermonters that they have the right to file a complaint if charged incorrect out-pocket costs or request an external appeal if denied coverage for services.

"Many Vermonters are unsure what their health insurance covers, or what to do if they receive a bill they weren't expecting," said DFR Commissioner Kaj Samsom. "This campaign is about empowering Vermonters with clear information about what services should be covered, how to find care, and how to get help if their insurance company isn't following the law."

The campaign builds on recent work by DFR related to access to reproductive health care in Vermont. In 2023, a DFR investigation found that several insurers were improperly processing claims for contraceptive services, resulting in consumers being incorrectly charged out-of-pocket costs. As a result of that investigation, insurers paid more than $1.5 million in restitution payments to nearly 9,000 Vermonters.

Following that investigation, DFR commissioned a comprehensive study to better understand barriers to accessing reproductive and preventive health services through commercial insurance in Vermont. The study was conducted by NORC at the University of Chicago and included analysis of existing survey and claims data, reviews of insurance policies, and interviews with health care and public health stakeholders across the state.

Study Finds Persistent Barriers to Accessing Reproductive Health Care in Vermont

The study found that Vermont performs well compared to other states on many measures of reproductive health and access to care. However, many Vermonters face barriers to accessing health services, including:

• Uncertainty about insurance coverage, including what services must be covered at low or no cost and how to resolve billing or coverage issues
• Limited provider availability, particularly for reproductive, maternal, and behavioral health services
• Transportation challenges and long travel distances, especially in rural areas
• Long wait times for appointments, driven by health workforce shortages and clinic closures

These barriers can lead Vermonters to delay or forgo care, even when services are legally required to be covered by insurers at low or no cost.

Campaign Goals and Resources

Through social media, a new web landing page, and print materials, the campaign aims to help Vermonters:

• Learn how state laws require insurance companies to cover telehealth, reproductive and contraceptive health services, often at low or no cost
• Know what steps to take if they are denied coverage or charged incorrect out-of-pocket costs for services
• Understand DFR's role in regulating insurance companies and how DFR can help them by responding to consumer complaints

DFR is working with partners including state agencies, health care providers, and community organizations to amplify and share the campaign across Vermont.

More information for Vermonters, including resources to help understand your insurance coverage, find telehealth services, and file a complaint, is available at: dfr.vermont.gov/coveredcare

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Funding Acknowledgment

This study and outreach campaign are supported through funding awarded to the State of Vermont by the Centers for Medicare & Medicaid Services to improve access to essential women's health services.