Vermont 2025-2026 Regular Session

Vermont Senate Bill S0132 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	BILL AS INTRODUCED S.132
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5	5	VT LEG #379182 v.1
6	6	S.132 1
7	7	Introduced by Senators White, Clarkson, Gulick, Major and Vyhovsky 2
8	8	Referred to Committee on 3
9	9	Date: 4
10	10	Subject: Health; health coverage; health care sharing plan or arrangement; 5
11	11	Department of Financial Regulation; reporting 6
12	12	Statement of purpose of bill as introduced: This bill proposes to require a 7
13	13	person who is not authorized to offer health insurance in Vermont and who 8
14	14	offers or intends to offer a health care sharing plan or arrangement to facilitate 9
15	15	payment or reimbursement of health care costs or services for Vermont 10
16	16	residents to report certain information annually to the Commissioner of 11
17	17	Financial Regulation and to certify the accuracy of the information. The bill 12
18	18	would direct the Commissioner of Financial Regulation to prepare an annual 13
19	19	report summarizing the information and post it on the Department of Financial 14
20	20	Regulation’s website. 15
21	21	An act relating to annual reporting on health care sharing plans and 16
22	22	arrangements 17 BILL AS INTRODUCED S.132
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26	26	VT LEG #379182 v.1
27	27	It is hereby enacted by the General Assembly of the State of Vermont: 1
28	28	Sec. 1. 8 V.S.A. § 4078 is added to read: 2
29	29	§ 4078. HEALTH CARE SHARING PLAN OR ARRANGEMENT; 3
30	30	REPORTING AND CERTIFICATION 4
31	31	(a) A person who is not authorized by the Commissioner under chapter 5
32	32	101, 123, 125, or 139 of this title to offer insurance in this State and who offers 6
33	33	or intends to offer a plan or arrangement to facilitate payment or 7
34	34	reimbursement of health care costs or services for residents of this State, 8
35	35	regardless of whether the person is domiciled in this State or another state, 9
36	36	shall submit to the Commissioner on or after October 1, 2025 and on or after 10
37	37	March 1 each year thereafter: 11
38	38	(1) the following information: 12
39	39	(A) the total number of individuals and households that participated 13
40	40	in the plan or arrangement in this State in the immediately preceding calendar 14
41	41	year; 15
42	42	(B) the total number of employer groups that participated in the plan 16
43	43	or arrangement in this State in the immediately preceding calendar year, 17
44	44	specifying the total number of participating individuals in each participating 18
45	45	employer group; 19
46	46	(C) if the person offers a plan or arrangement in other states, the total 20
47	47	number of participants in the plan or arrangement nationally; 21 BILL AS INTRODUCED S.132
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52	52	(D) any contracts the person has entered into with providers in this 1
53	53	State who provide health care services to plan or arrangement participants; 2
54	54	(E) the total amount of fees, dues, or other payments collected by the 3
55	55	person in the immediately preceding calendar year from individuals, employer 4
56	56	groups, or others who participated in the plan or arrangement, specifying the 5
57	57	percentage of fees, dues, or other payments retained by the person for 6
58	58	administrative expenses; 7
59	59	(F) the total dollar amount of requests for reimbursement of health 8
60	60	care costs or services that were submitted in this State in the immediately 9
61	61	preceding calendar year by plan or arrangement participants or providers who 10
62	62	provided health care services to plan or arrangement participants; 11
63	63	(G) the total dollar amount of requests for reimbursement of health 12
64	64	care costs or services that were submitted in this State and were determined to 13
65	65	qualify for reimbursement under the plan or arrangement in the immediately 14
66	66	preceding calendar year; 15
67	67	(H) the total dollar amount of payments made to providers in this 16
68	68	State in the immediately preceding calendar year for health care services that 17
69	69	were provided to or received by plan or arrangement participants; 18
70	70	(I) the total dollar amount of reimbursements made to plan or 19
71	71	arrangement participants in this State in the immediately preceding calendar 20 BILL AS INTRODUCED S.132
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75	75	VT LEG #379182 v.1
76	76	year for health care services provided to or received by a plan or arrangement 1
77	77	participant; 2
78	78	(J) the total number of requests for reimbursement of health care 3
79	79	costs or services submitted in this State in the immediately preceding calendar 4
80	80	year that were denied, expressed as a percentage of total reimbursement 5
81	81	requests submitted in that calendar year, and the total number of 6
82	82	reimbursement request denials that were appealed; 7
83	83	(K) the total dollar amount of health care expenses submitted in this 8
84	84	State by plan or arrangement participants or providers in the immediately 9
85	85	preceding calendar year that qualify for reimbursement pursuant to the plan or 10
86	86	arrangement criteria but that, as of the end of that calendar year, have not been 11
87	87	reimbursed, excluding any amounts that the plan or arrangement participants 12
88	88	incurring the health care costs must pay before receiving reimbursement under 13
89	89	the plan or arrangement; 14
90	90	(L) the estimated number of plan or arrangement participants the 15
91	91	person anticipates in this State in the next calendar year, specifying the number 16
92	92	of individuals, households, employer groups, and employees; 17
93	93	(M) a list of other states in which the person offers a plan or 18
94	94	arrangement; 19
95	95	(N) a list of any third parties, other than a licensed insurance 20
96	96	producer, that are associated with or assist the person in offering or enrolling 21 BILL AS INTRODUCED S.132
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100	100	VT LEG #379182 v.1
101	101	participants in this State in the plan or arrangement, copies of any training 1
102	102	materials provided to a third party, and a detailed accounting of any 2
103	103	commissions or other feeds or remuneration paid to a third party in the 3
104	104	immediately preceding calendar year for: 4
105	105	(i) marketing, promoting, or enrolling participants in a plan or 5
106	106	arrangement offered by the person in this State; or 6
107	107	(ii) operating, managing, or administering a plan or arrangement 7
108	108	offered by the person in this State; 8
109	109	(O) the total number of licensed insurance producers that are 9
110	110	associated with or assist the person in offering or enrolling participants in this 10
111	111	State in the plan or arrangement, the total number of participants enrolled in 11
112	112	the plan or arrangement through a licensed insurance producer, copies of any 12
113	113	training materials provided to a producer, and a detailed accounting of any 13
114	114	commissions or other fees or remuneration paid to a producer in the 14
115	115	immediately preceding calendar year for marketing, promoting, or enrolling 15
116	116	participants in a plan or arrangement offered by the person in this State; 16
117	117	(P) copies of any consumer-facing and marketing materials used in 17
118	118	this State in promoting the person’s plan or arrangement, including plan or 18
119	119	arrangement descriptions, benefit descriptions, and other materials that explain 19
120	120	the plan or arrangement; 20 BILL AS INTRODUCED S.132
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125	125	(Q) the name, mailing address, email address, and telephone number 1
126	126	of an individual serving as a contact for the person in this State; 2
127	127	(R) a list of any parent companies, subsidiaries, and other names that 3
128	128	the person has operated under at any time within the immediately preceding 4
129	129	five calendar years; and 5
130	130	(S) an organizational chart of the person and a list of the officers and 6
131	131	directors of the person; and 7
132	132	(2) a certification by an officer of the person that, to the best of the 8
133	133	person’s good-faith knowledge and belief, the information submitted is 9
134	134	accurate and satisfies the requirements of this subsection. 10
135	135	(b)(1) If a person subject to the requirements of subsection (a) of this 11
136	136	section fails to submit the information required by that subsection, the 12
137	137	submission is incomplete. The Commissioner shall make a determination of 13
138	138	completeness not later than 45 days after the submission is received. If the 14
139	139	Commissioner has not informed the person of any deficiencies in the 15
140	140	submission within 45 days after receiving the submission, the submission is 16
141	141	considered complete. 17
142	142	(2)(A) If the Commissioner determines that a person has failed to 18
143	143	comply with the requirements of subsection (a) of this section, the 19
144	144	Commissioner shall: 20 BILL AS INTRODUCED S.132
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149	149	(i) notify the person that the submission is incomplete and 1
150	150	enumerate in the notification each deficiency found in the person’s submission; 2
151	151	and 3
152	152	(ii) allow the person 30 days after notice of the incomplete 4
153	153	submission to remedy the deficiency found in the submission. 5
154	154	(B) If the person does not remedy the deficiency within the 30-day 6
155	155	period, the Commissioner may impose an administrative penalty not to exceed 7
156	156	$5,000.00 per day. 8
157	157	(C) If the person does not remedy the deficiency or deficiencies 9
158	158	within 30 days after the initial administrative penalty is imposed, the 10
159	159	Commissioner may issue cease and desist order pursuant to section 2110 of 11
160	160	this title. 12
161	161	(c) On or before April 1, 2026 and on or before each October 1 thereafter, 13
162	162	the Commissioner shall: 14
163	163	(1) prepare a written report summarizing the information submitted by 15
164	164	persons pursuant to subsection (a) of this section; and 16
165	165	(2) post the report on the Department’s website, along with accurate and 17
166	166	evidence-based information about the persons who submitted information 18
167	167	pursuant to subsection (a) of this section, including how consumers may file 19
168	168	complaints. 20 BILL AS INTRODUCED S.132
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173	173	(d) The Commissioner may adopt rules as necessary to implement this 1
174	174	section. 2
175	175	Sec. 2. EFFECTIVE DATE 3
176	176	This act shall take effect on passage. 4