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