Signed by Governor Peter Shumlin

Vote Smart's Synopsis:

Vote to pass a bill that establishes a health benefit exchange in Vermont in conjunction with the Patient Protection and Affordable Care Act.

Highlights:

• Authorizes the merging of individual and small group insurance markets (Sec. 3).

• Defines “small employer” as an employer that (Sec. 3):
• As of January 1, 2016, will have between 1 and 50 employees during the last calendar quarter who are not part-time workers, that work less than 30 hours per week; or
• Prior to January 1, 2016, has between 1 and 100 employees during the last calendar quarter who are not part-time workers, that work less than 30 hours per week.

• Specifies that self-employed persons are also eligible for the exchange (Sec. 3).

• Specifies that no person may provide a health benefit plan to an individual or small employer unless the plan is offered through the Vermont health care benefit exchange and the provider is a registered carrier (Sec. 3).

• Defines “registered carrier” as a person who is registered with the commissioner of banking, insurance, securities, and healthcare administration to issue a health benefit plan (Sec. 3).

• Specifies that registered carriers are not insurance agents, brokers, appraisers, or adjusters (Sec. 3).

• Effective date of merging of individual and small employer insurance markets is January 1, 2013 (Sec. 42).

• Requires a registered carrier to guarantee acceptance to any health plan he or she offers to the following groups (Sec. 3):
• Individuals;
• Small employers and their employees; and
• Each dependant of those individuals and employees.

• Prohibits use of the following factors to play a role in a provider/carrier’s rating methods (Secs. 3 & 4):
• Demographic rating (including race and gender);
• Geographic area rating;
• Medical underwriting and screening;
• Experience rating;
• Tier rating; and
• Durational rating.

• Prohibits the use of discretionary clauses by carriers in providing health insurance benefits, disability income protection coverage, and life insurance benefits (Sec. 31).

• Effective date of prohibition on the discretionary clause is January 1, 2013 (Sec. 42).

• Specifies and expands the duties and provisions of the Green Mountain Care Board (GMCB) (Sec. 5).

• Requires the GMCB to develop a unified health care budget and develop an expenditure analysis (Secs. 12 & 13).

• Specifies the GMCB as the means of administration in carrying out health care provisions and programs (Secs. 14-23).

• Authorizes the health care commissioner and GMCB as the main authorities in enforcement of these regulations (Sec. 14).

• Repeals the Catamount Health and Vermont Health Access Plan upon implementation of the health benefit exchange (Sec. 41).

• Specifies the Unified Health Care Budget and new authority of the GMCB effective immediately upon bill passage (Sec. 42).

Full Bill Text