2012 Vermont Statutes
Title 08 Banking and Insurance
Chapter 107 HEALTH INSURANCE
§ 4089l Health care claims assessment

§ 4089l. Health care claims assessment

(a)(1) Each health insurer shall pay an assessment into the state health care resources fund established in 33 V.S.A. § 1901d in the amount of 0.80 of one percent of all health insurance claims paid by the health insurer for its Vermont members in the previous fiscal year ending June 30. The annual fee shall be paid in one installment due by January 1.

(2) On or before October 1, 2011 and annually thereafter, the secretary of administration, in consultation with the commissioner of financial regulation, shall publish a list of health insurers subject to the fee imposed by this section together with the paid claims amounts attributable to each health insurer for the previous fiscal year. The costs of the department of financial regulation in calculating the annual claims data shall be paid from the state health care resources fund.

(b) It is the intent of the general assembly that all health insurers shall contribute equitably to the state health care resources fund. In the event that the assessment established in subsection (a) of this section is found not to be enforceable as applied to third-party administrators or other entities, the assessment amounts owed by all other health insurers shall remain at existing levels and the general assembly shall consider alternative funding mechanisms that would be enforceable as to all health insurers.

(c) As used in this section:

(1) "Health insurance" means any group or individual health care benefit policy, contract, or other health benefit plan offered, issued, renewed, or administered by any health insurer, including any health care benefit plan offered, issued, renewed, or administered by any health insurance company, any nonprofit hospital and medical service corporation, any dental service corporation, or any managed care organization as defined in 18 V.S.A. § 9402. The term includes comprehensive major medical policies, contracts, or plans and Medicare supplemental policies, contracts, or plans, but does not include Medicaid, VHAP, or any other state health care assistance program financed in whole or in part through a federal program, unless authorized by federal law and approved by the general assembly. The term does not include policies issued for specified disease, accident, injury, hospital indemnity, long-term care, disability income, or other limited benefit health insurance policies, ex

cept that any policy providing coverage for dental services shall be included.

(2) "Health insurer" means any person who offers, issues, renews, or administers a health insurance policy, contract, or other health benefit plan in this state and includes third-party administrators or pharmacy benefit managers who provide administrative services only for a health benefit plan offering coverage in this state. The term does not include a third-party administrator or pharmacy benefit manager to the extent that a health insurer has paid the fee which would otherwise be imposed in connection with health care claims administered by the third-party administrator or pharmacy benefit manager. The term also does not include a health insurer with a monthly average of fewer than 200 Vermont insured lives.

(d) If any health insurer fails to pay the fee established in subsection (a) of this section within 45 days after the installment due date, the secretary of administration or his or her designee shall notify the commissioner of financial regulation of the failure to pay. In addition to any other remedy or sanction provided for by law, if the commissioner finds, after notice and an opportunity to be heard, that the health insurer has violated this section or any rule or order adopted or issued pursuant to this section, the commissioner may take any one or more of the following actions:

(1) Assess an administrative penalty on the health insurer of not more than $1,000.00 for each violation and not more than $10,000.00 for each willful violation;

(2) Order the health insurer to cease and desist in further violations;

(3) Order the health insurer to remediate the violation, including the payment of fees in arrears and payment of interest on fees in arrears at the rate of 12 percent per annum. (Added 2011, No. 45, § 28, eff. May 24, 2011; 2011, No. 75 (Adj. Sess.), § 104, eff. Jan. 1, 2012; No. 78 (Adj. Sess.), § 2, eff. April 2, 2012; No. 162 (Adj. Sess.), § E.306.2.)