| 1 | 1 | | BILL AS INTRODUCED H.430 |
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| 2 | 2 | | 2025 Page 1 of 4 |
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| 5 | 5 | | VT LEG #380505 v.1 |
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| 6 | 6 | | H.430 1 |
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| 7 | 7 | | Introduced by Representatives Galfetti of Barre Town and Waszazak of Barre 2 |
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| 8 | 8 | | City 3 |
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| 9 | 9 | | Referred to Committee on 4 |
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| 10 | 10 | | Date: 5 |
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| 11 | 11 | | Subject: Health; health insurance; age rating; tobacco rating 6 |
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| 12 | 12 | | Statement of purpose of bill as introduced: This bill proposes to allow health 7 |
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| 13 | 13 | | insurers in Vermont to vary premiums for individual and small group health 8 |
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| 14 | 14 | | insurance plans based on beneficiary age and tobacco usage. 9 |
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| 15 | 15 | | An act relating to allowing health insurance premiums to vary based on age 10 |
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| 16 | 16 | | and tobacco usage 11 |
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| 17 | 17 | | It is hereby enacted by the General Assembly of the State of Vermont: 12 |
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| 18 | 18 | | Sec. 1. 33 V.S.A. § 1811 is amended to read: 13 |
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| 19 | 19 | | § 1811. HEALTH BENEFIT PLANS FOR INDIVIDUALS AND SMALL 14 |
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| 20 | 20 | | EMPLOYERS 15 |
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| 21 | 21 | | * * * 16 |
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| 22 | 22 | | (f)(1) A registered carrier shall use a community rating method acceptable 17 |
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| 23 | 23 | | to the Commissioner of Financial Regulation for determining premiums for 18 |
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| 24 | 24 | | health benefit plans. Except as provided in subdivision (2) of this subsection, 19 |
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| 25 | 25 | | the following risk classification factors are prohibited from use in rating 20 BILL AS INTRODUCED H.430 |
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| 26 | 26 | | 2025 Page 2 of 4 |
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| 28 | 28 | | |
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| 29 | 29 | | VT LEG #380505 v.1 |
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| 30 | 30 | | individuals, small employers, or employees of small employers, or the 1 |
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| 31 | 31 | | dependents of such individuals or employees: 2 |
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| 32 | 32 | | (A) demographic rating, including age and gender rating; 3 |
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| 33 | 33 | | (B) geographic area rating; 4 |
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| 34 | 34 | | (C) industry rating; 5 |
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| 35 | 35 | | (D) medical underwriting and screening; 6 |
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| 36 | 36 | | (E) experience rating; 7 |
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| 37 | 37 | | (F) tier rating; or 8 |
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| 38 | 38 | | (G) durational rating. 9 |
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| 39 | 39 | | (2)(A)(i) A registered carrier may vary the premium rate for a health 10 |
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| 40 | 40 | | benefit plan as follows: 11 |
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| 41 | 41 | | (I) based on age, provided that the maximum rate differential 12 |
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| 42 | 42 | | for age as determined by ratio shall not exceed 3 to 1; and 13 |
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| 43 | 43 | | (II) based on tobacco usage, provided that the maximum rate 14 |
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| 44 | 44 | | differential for tobacco usage as determined by ratio shall not exceed 1.5 to 1. 15 |
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| 45 | 45 | | (ii) The Commissioner of Financial Regulation shall, by rule, 16 |
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| 46 | 46 | | adopt standards and a process for permitting registered carriers to use one or 17 |
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| 47 | 47 | | more risk classifications in their community rating method in addition to those 18 |
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| 48 | 48 | | specified in subdivision (i) of this subdivision (2)(A), provided that the 19 |
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| 49 | 49 | | premium charged shall not deviate above or below the community rate filed by 20 |
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| 50 | 50 | | the carrier by more than 20 percent after the application of age and tobacco 21 BILL AS INTRODUCED H.430 |
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| 51 | 51 | | 2025 Page 3 of 4 |
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| 54 | 54 | | VT LEG #380505 v.1 |
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| 55 | 55 | | rating, if applicable, and provided further that the Commissioner of Financial 1 |
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| 56 | 56 | | Regulation’s rules may not permit any medical underwriting and screening and 2 |
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| 57 | 57 | | shall give due consideration to the need for affordability and accessibility of 3 |
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| 58 | 58 | | health insurance. 4 |
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| 59 | 59 | | (B) The Commissioner of Financial Regulation’s rules shall permit a 5 |
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| 60 | 60 | | carrier, including a hospital or medical service corporation and a health 6 |
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| 61 | 61 | | maintenance organization, to establish rewards, premium discounts, split 7 |
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| 62 | 62 | | benefit designs, rebates, or otherwise waive or modify applicable co-payments, 8 |
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| 63 | 63 | | deductibles, or other cost-sharing amounts in return for adherence by a 9 |
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| 64 | 64 | | member or subscriber to programs of health promotion and disease prevention. 10 |
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| 65 | 65 | | The Commissioner of Financial Regulation shall consult with the 11 |
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| 66 | 66 | | Commissioner of Health, the Director of the Blueprint for Health, and the 12 |
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| 67 | 67 | | Commissioner of Vermont Health Access in the development of health 13 |
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| 68 | 68 | | promotion and disease prevention rules that are consistent with the Blueprint 14 |
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| 69 | 69 | | for Health. Such rules shall: 15 |
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| 70 | 70 | | (i) limit any reward, discount, rebate, or waiver or modification of 16 |
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| 71 | 71 | | cost-sharing amounts to not more than a total of 15 percent of the cost of the 17 |
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| 72 | 72 | | premium for the applicable coverage tier, provided that the sum of any rate 18 |
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| 73 | 73 | | deviations under subdivision (A) of this subdivision (2) does not exceed 30 19 |
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| 74 | 74 | | percent after the application of age and tobacco rating, if applicable; 20 |
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| 75 | 75 | | * * * 21 BILL AS INTRODUCED H.430 |
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| 76 | 76 | | 2025 Page 4 of 4 |
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| 79 | 79 | | VT LEG #380505 v.1 |
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| 80 | 80 | | Sec. 2. EFFECTIVE DATE 1 |
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| 81 | 81 | | This act shall take effect on January 1, 2026. 2 |
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