VT
Vermont House Bill H0035

Vermont 2025-2026 Regular Session

Vermont House Bill H0035 Compare Versions

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5-No. 2. An act relating to unmerging the individual and small group health
6-insurance markets.
7-(H.35)
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3+H.35
4+IntroducedbyRepresentativeHoughtonofEssexJunction
5+ReferredtoCommitteeon
6+Date:
7+Subject:Health;healthinsurance;VermontHealthBenefitExchange;
8+unmergedmarkets
9+Statementofpurposeofbillasintroduced:Thisbillproposestounmergethe
10+individualandsmallgrouphealthinsurancemarkets.Itwouldalsorepeal
11+outdatedlanguageregardingimplementationoftheVermontHealthBenefit
12+Exchange.
13+Anactrelatingtounmergingtheindividualandsmallgrouphealth
14+insurancemarkets
815 ItisherebyenactedbytheGeneralAssemblyoftheStateofVermont:
9-Sec. 1. 33 V.S.A. § 1802 is amended to read:
16+Sec.1.33V.S.A.§ 1802isamendedtoread:
1017 §1802.DEFINITIONS
1118 Asusedinthissubchapter:
1219 ***
1320 (5)“Qualifiedemployer”:
1421 (A)meansanentitythatemployedanaverageofnotmorethan50
1522 100employeesonworkingdaysduringtheprecedingcalendaryearandthat:
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1644 (i)(A)hasitsprincipalplaceofbusinessinthisStateandelectsto
1745 providecoverageforitseligibleemployeesthroughtheVermontHealth
1846 BenefitExchange,regardlessofwhereanemployeeresides;or
1947 (ii)(B)electstoprovidecoveragethroughtheVermontHealth
2048 BenefitExchangeforallofitseligibleemployeeswhoareprincipally
2149 employedinthisState;
2250 (B)onandafterJanuary1,2016,shallincludeanentitythat:
2351 (i)employedanaverageofnotmorethan100employeeson
2452 workingdaysduringtheprecedingcalendaryear;and
25-(ii) meets the requirements of subdivisions (A)(i) and (A)(ii) of this
26-subdivision (5).
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53+(ii)meetstherequirementsofsubdivisions(A)(i)and(A)(ii)of
54+thissubdivision(5).
55+(C)[Repealed.]
3156 ***
32-Sec. 2. 33 V.S.A. § 1804 is amended to read:
57+Sec.2.33V.S.A.§ 1804isamendedtoread:
3358 §1804.QUALIFIEDEMPLOYERS
3459 (a)(1)UntilJanuary1,2016,aqualifiedemployershallbeanentitythat
3560 employedanaverageofnotmorethan50employeesonworkingdaysduring
3661 theprecedingcalendaryear,andtheterm“qualifiedemployer”includesself-
3762 employedpersonstotheextentpermittedundertheAffordableCareAct.
3863 Calculationofthenumberofemployeesofaqualifiedemployershallnot
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3985 includeapart-timeemployeewhoworksfewerthan30hoursperweekora
4086 seasonalworkerasdefinedin26U.S.C.§4980H(c)(2)(B).
4187 (2)Anemployerwith50orfeweremployeesthatoffersaqualified
4288 healthbenefitplantoitsemployeesthroughtheVermontHealthBenefit
4389 ExchangemaycontinuetoparticipateintheExchangeeveniftheemployer’s
4490 sizegrowsbeyond50employees,aslongastheemployercontinuouslymakes
4591 qualifiedhealthbenefitplansintheVermontHealthBenefitExchange
4692 availabletoitsemployees.[Repealed.]
4793 (b)(1)OnandafterJanuary1,2016,aAqualifiedemployershallbean
4894 entitythatemployedanaverageofnotmorethan100employeesonworking
4995 daysduringtheprecedingcalendaryear,andtheterm“qualifiedemployer”
5096 includesself-employedpersonstotheextentpermittedundertheAffordable
5197 CareAct.Thenumberofemployeesshallbecalculatedusingthemethodset
52-forth in 26 U.S.C. § 4980H(c)(2). No. 2 Page 3 of 9
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98+forthin26U.S.C.§4980H(c)(2).
5699 (2)Anemployerwith100orfeweremployeesthatoffersaqualified
57100 healthbenefitplantoitsemployeesthroughtheVermontHealthBenefit
58101 ExchangemaycontinuetoparticipateintheExchangeeveniftheemployer’s
59102 sizegrowsbeyond100employees,aslongasprovidedtheemployer
60103 continuouslymakesqualifiedhealthbenefitplansintheVermontHealth
61104 BenefitExchangeavailabletoitsemployees.
62105 (c)[Repealed.]
63-Sec. 3. 33 V.S.A. § 1805 is amended to read:
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128+Sec.3.33V.S.A.§ 1805isamendedtoread:
64129 §1805.DUTIESANDRESPONSIBILITIES
65130 TheVermontHealthBenefitExchangeshallhavethefollowingdutiesand
66131 responsibilitiesconsistentwiththeAffordableCareAct:
67132 ***
68133 (7)transferringtotheSecretaryoftheU.S.DepartmentoftheTreasury
69134 thenameandtaxpayeridentificationnumberofeachindividualwhowasan
70135 employeeofanemployerbutwhowasdeterminedtobeeligibleforthe
71136 premiumtaxcreditunderSection36BoftheInternalRevenueCodeof1986,
72137 includingeachindividualwhowasanemployeeofanemployerbutwhowas
73138 determinedtobeeligibleforthepremiumtaxcreditforoneofthefollowing
74139 reasons:
75140 (A)theemployerdidnotprovideminimumessentialcoverage;or
76141 (B)theemployerprovidedtheminimumessentialcoverage,butit
77-was determined under Section 36B(c)(2)(C) of the Internal Revenue Code to No. 2 Page 4 of 9
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142+wasdeterminedunderSection36B(c)(2)(C)oftheInternalRevenueCodeto
81143 beeitherunaffordabletotheemployeeornottoprovidetherequiredminimum
82144 actuarialvalue;
83145 ***
84146 (9)(A)transferringtotheSecretaryoftheU.S.Departmentofthe
85147 Treasurythenameandtaxpayeridentificationnumberofeachindividualwho
86148 notifiestheVermontHealthBenefitExchangethatheorshehaschanged
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87171 employersandofeachindividualwhoceasescoverageunderaqualifiedhealth
88172 benefitplanduringaplanyearandtheeffectivedateofthatcessation;and
89173 (B)communicatingtoeachemployerthenameofeachofits
90174 employeesandtheeffectivedateofthecessationreportedtotheU.S.
91175 DepartmentoftheTreasuryunderthissubdivision;
92176 ***
93177 (17)establishingprocedures,includingpaymentmechanismsand
94178 standardfeeorcompensationschedules,thatallowlicensedinsuranceagents
95179 andbrokerstobeappropriatelycompensatedoutsidethenavigatorprogram
96180 establishedinsection1807ofthistitlefor:
97181 (A)assistingassistwiththeenrollmentofqualifiedindividualsand
98182 qualifiedemployersinanyqualifiedhealthplanofferedthroughtheExchange
99183 forwhichtheindividualoremployeriseligible;and
100184 (B)assistingassistqualifiedindividualsinapplyingforpremiumtax
101185 creditsandcost-sharingreductionsforqualifiedhealthbenefitplanspurchased
102-through the Exchange. No. 2 Page 5 of 9
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106-Sec. 4. 33 V.S.A. § 1811 is amended to read:
186+throughtheExchange.
187+Sec.4.33V.S.A.§ 1811isamendedtoread:
107188 §1811.HEALTHBENEFITPLANSFORINDIVIDUALSANDSMALL
108189 EMPLOYERS
109190 (a)Asusedinthissection:
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110212 (1)“Healthbenefitplan”meansahealthinsurancepolicy,anonprofit
111213 hospitalormedicalservicecorporationservicecontract,orahealth
112214 maintenanceorganizationhealthbenefitplanofferedthroughtheVermont
113215 HealthBenefitExchangeorareflectivehealthbenefitplanofferedin
114216 accordancewithsection1813ofthistitlethatisissuedtoanindividualinthe
115217 individualmarketortoanemployeeofasmallemployerinthesmallgroup
116218 market.Thetermdoesnotincludecoverageonlyforaccidentordisability
117219 incomeinsurance,liabilityinsurance,coverageissuedasasupplementto
118220 liabilityinsurance,workers’compensationorsimilarinsurance,automobile
119221 medicalpaymentinsurance,credit-onlyinsurance,coverageforon-site
120222 medicalclinics,orothersimilarinsurancecoverageinwhichbenefitsfor
121223 healthservicesaresecondaryorincidentaltootherinsurancebenefitsas
122-provided under the Affordable Care Act. The term also does not include stand-
123-alone dental or vision benefits; long-term care insurance; short-term, limited-
124-duration health insurance; specific disease or other limited benefit coverage;
125-Medicare supplemental health benefits; Medicare Advantage plans; and other
126-similar benefits excluded under the Affordable Care Act. No. 2 Page 6 of 9
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224+providedundertheAffordableCareAct.Thetermalsodoesnotinclude
225+stand-alonedentalorvisionbenefits;long-termcareinsurance;short-term,
226+limited-durationhealthinsurance;specificdiseaseorotherlimitedbenefit
227+coverage;Medicaresupplementalhealthbenefits;MedicareAdvantageplans;
228+andothersimilarbenefitsexcludedundertheAffordableCareAct.
130229 (2)“Registeredcarrier”meansanyperson,exceptaninsuranceagent,
131230 broker,appraiser,oradjuster,whoissuesahealthbenefitplanandwhohasa
132231 registrationineffectwiththeCommissionerofFinancialRegulationas
133232 requiredbythissection.
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134255 (3)(A)UntilJanuary1,2016,“smallemployer”meansanentitythat
135256 employedanaverageofnotmorethan50employeesonworkingdaysduring
136257 theprecedingcalendaryear.Thetermincludesself-employedpersonstothe
137258 extentpermittedundertheAffordableCareAct.Calculationofthenumberof
138259 employeesofasmallemployershallnotincludeapart-timeemployeewho
139260 worksfewerthan30hoursperweekoraseasonalworkerasdefinedin26
140261 U.S.C.§4980H(c)(2)(B).Anemployermaycontinuetoparticipateinthe
141262 Exchangeeveniftheemployer’ssizegrowsbeyond50employees,aslongas
142263 theemployercontinuouslymakesqualifiedhealthbenefitplansintheVermont
143264 HealthBenefitExchangeavailabletoitsemployees.
144265 (B)BeginningonJanuary1,2016,“small“Smallemployer”means
145266 anentitythatemployedanaverageofnotmorethan100employeeson
146267 workingdaysduringtheprecedingcalendaryear.Thetermincludesself-
147268 employedpersonstotheextentpermittedundertheAffordableCareAct.The
148269 numberofemployeesshallbecalculatedusingthemethodsetforthin26
149270 U.S.C.§4980H(c)(2).Anemployermaycontinuetoparticipateinthe
150-Exchange even if the employer’s size grows beyond 100 employees, as long as No. 2 Page 7 of 9
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271+Exchangeeveniftheemployer’ssizegrowsbeyond100employees,aslongas
154272 providedtheemployercontinuouslymakesqualifiedhealthbenefitplansinthe
155273 VermontHealthBenefitExchangeavailabletoitsemployees.
156274 (b)(1)TotheextentpermittedbytheU.S.DepartmentofHealthand
157275 HumanServices,anAnindividualmaypurchaseahealthbenefitplanthrough
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158298 theExchangewebsite,throughnavigators,bytelephone,ordirectlyfroma
159299 registeredcarrierundercontractwiththeVermontHealthBenefitExchange,if
160300 thecarrierelectstomakedirectenrollmentavailable.Aregisteredcarrier
161301 enrollingindividualsinhealthbenefitplansdirectlyshallcomplywithallopen
162302 enrollmentandspecialenrollmentperiodsapplicabletotheVermontHealth
163303 BenefitExchange.
164304 (2)TotheextentpermittedbytheU.S.DepartmentofHealthand
165305 HumanServices,aAsmallemployeroranemployeeofasmallemployermay
166306 purchaseahealthbenefitplanthroughtheExchangewebsite,through
167307 navigators,bytelephone,ordirectlyfromaregisteredcarrierundercontract
168308 withtheVermontHealthBenefitExchange.
169309 (3)Nopersonmayprovideahealthbenefitplantoanindividualortoa
170310 smallemployerunlesstheplancomplieswiththeprovisionsofthissubchapter.
171311 (c)Nopersonmayprovideahealthbenefitplantoanindividualortoa
172312 smallemployerunlesssuchpersonisaregisteredcarrier.TheCommissioner
173313 ofFinancialRegulationshallestablish,byrule,theminimumfinancial,
174314 marketing,service,andotherrequirementsforregistration.Suchregistration
175-shall be effective upon approval by the Commissioner of Financial Regulation No. 2 Page 8 of 9
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315+shallbeeffectiveuponapprovalbytheCommissionerofFinancialRegulation
179316 andshallremainineffectuntilrevokedorsuspendedbytheCommissionerof
180317 FinancialRegulationforcauseoruntilwithdrawnbythecarrier.Acarrier
181318 maywithdrawitsregistrationuponatleastsixmonths’priorwrittennoticeto
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182341 theCommissionerofFinancialRegulation.Aregistrationfiledwiththe
183342 CommissionerofFinancialRegulationshallbedeemedtobeapprovedunless
184343 itisdisapprovedbytheCommissionerofFinancialRegulationwithin30days
185344 offiling.
186345 (d)(1)Guaranteedissue.
187346 (A)Aregisteredcarriershallguaranteeacceptanceofallindividuals,
188347 smallemployers,andemployeesofsmallemployers,andeachdependentof
189348 suchindividualsandemployees,andtheirdependentsforanyhealthbenefit
190349 planofferedbythecarrierintheindividualmarket,regardlessofany
191350 outstandingpremiumamountasubscribermayowetothecarrierforcoverage
192351 providedduringthepreviousplanyear.
193352 (B)Aregisteredcarriershallguaranteeacceptanceofallsmall
194353 employers,theiremployees,andtheiremployees’dependentsforanyhealth
195354 benefitplanofferedbythecarrierinthesmallgroupmarket,regardlessofany
196355 outstandingpremiumamountasubscribermayowetothecarrierforcoverage
197356 providedduringthepreviousplanyear.
198357 ***
199358 (f)(1)Aregisteredcarriershalluseacommunityratingmethodacceptable
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359+totheCommissionerofFinancialRegulationfordeterminingpremiumsfor
204360 healthbenefitplansandshalldeterminethepremiumsforthecarrier’s
205361 individualmarketplansseparatelyfromthepremiumsforitssmallgroup
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206384 marketplans.Exceptasprovidedinsubdivision(2)ofthissubsection,the
207385 followingriskclassificationfactorsareprohibitedfromuseinrating
208386 individuals,smallemployers,oremployeesofsmallemployers,orthe
209387 dependentsofsuchindividualsoremployees:
210388 ***
211389 (k)Theguaranteedacceptanceprovisionofsubsection(d)ofthissection
212390 shallnotbeconstruedtolimitanemployer’sdiscretionincontractingwithhis
213391 orhertheemployer’semployeesforinsurancecoverage.
214392 ***
215393 Sec.5.EFFECTIVEDATE
216394 ThisactshalltakeeffectonJanuary1,2026.
217-Date Governor signed bill: February 19, 2025
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