§ 10401. Definitions
As used in this chapter:
(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; short-term,
limited-duration health insurance policies and contracts as defined in 8 V.S.A. § 4053; student health insurance policies; and Medicare supplement insurance policies, contracts,
or plans, but does not include Medicaid or any other State health care assistance
program in which claims are 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,
except 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 that would otherwise be imposed in connection
with health care claims administered by the third party administrator or pharmacy
benefit manager. (Added 2013, No. 73, § 48; amended 2017, No. 131 (Adj. Sess.), § 4, eff. May 16, 2018; 2019, No. 14, § 83, eff. April 30, 2019; 2025, No. 11, § 27, eff. September 1, 2025.)
§ 10402. Health care claims tax [Effective until July 1, 2026; see also 32 V.S.A. § 10402 effective July 1, 2026 set out below]
(a) There is imposed on every health insurer an annual tax in an amount equal to 0.999
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 to
the Commissioner of Taxes in one installment due by January 1.
(b) Revenues paid and collected under this chapter shall be deposited as follows:
(1) 0.199 of one percent of all health insurance claims into the Health IT-Fund established
in section 10301 of this title; and
(2) 0.8 of one percent of all health insurance claims into the General Fund.
(c) The annual cost to obtain Vermont Healthcare Claims Uniform Reporting and Evaluation
System (VHCURES) data, pursuant to 18 V.S.A. § 9410, for use by the Department of Taxes shall be paid from the Vermont Health IT-Fund
and the General Fund in the same proportion as revenues are deposited into those Funds.
(d) It is the intent of the General Assembly that all health insurers shall contribute
equitably through the tax imposed in subsection (a) of this section. In the event
that the tax is found not to be enforceable as applied to third-party administrators
or other entities, the tax owed by all other health insurers shall remain at the existing
level and the General Assembly shall consider alternative funding mechanisms that
would be enforceable as to all health insurers. (Added 2013, No. 73, § 48; amended 2013, No. 73, § 53, eff. July 1, 2019; 2019, No. 6, § 72, eff. April 22, 2019.)
§ 10402. Health care claims tax [Effective July 1, 2026; see also 32 V.S.A. § 10402 effective until July 1, 2026 set out above]
(a) There is imposed on every health insurer an annual tax in an amount equal to 0.8 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 to
the Commissioner of Taxes in one installment due on or before January 1.
(b) Revenues paid and collected under this chapter shall be deposited into the General
Fund.
(c) The annual cost to obtain Vermont Healthcare Claims Uniform Reporting and Evaluation
System (VHCURES) data, pursuant to 18 V.S.A. § 9410, for use by the Department of Taxes shall be paid from the General Fund.
(d) It is the intent of the General Assembly that all health insurers shall contribute
equitably through the tax imposed in subsection (a) of this section. In the event
that the tax is found not to be enforceable as applied to third-party administrators
or other entities, the tax owed by all other health insurers shall remain at the existing
level and the General Assembly shall consider alternative funding mechanisms that
would be enforceable as to all health insurers. (Added 2013, No. 73, § 48; amended 2013, No. 73, § 53, eff. July 1, 2019; 2019, No. 6, § 72, eff. April 22, 2019; 2019, No. 6, § 73, eff. July 1, 2026.)
§ 10403. Administration of tax
(a) The Commissioner of Taxes shall administer and enforce this chapter and the tax. The
Commissioner may adopt rules under 3 V.S.A. chapter 25 to carry out such administration and enforcement.
(b) All of the administrative provisions of chapter 151 of this title, including those
relating to the collection and enforcement by the Commissioner of the withholding
tax and the income tax, shall apply to the tax imposed by this chapter. In addition,
the provisions of chapter 103 of this title, including those relating to the imposition
of interest and penalty for failure to pay the tax as provided in section 10402 of this title, shall apply to the tax imposed by this chapter. (Added 2013, No. 73, § 48.)
§ 10404. Determination of deficiency, refund, penalty, or interest
(a) Within 60 days after the mailing of a notice of deficiency, denial, or reduction of
a refund claim, or assessment of penalty or interest, a health insurer may petition
the Commissioner in writing for a determination of that deficiency, refund, or assessment.
The Commissioner shall thereafter grant a hearing upon the matter and notify the health
insurer in writing of his or her determination concerning the deficiency, penalty,
or interest. This is the exclusive remedy of a health insurer with respect to these
matters.
(b) Any hearing granted by the Commissioner under this section shall be subject to and
governed by 3 V.S.A. chapter 25.
(c) Any aggrieved health insurer may, within 30 days after a determination by the Commissioner
concerning a notice of deficiency, an assessment of penalty or interest, or a claim
to refund, appeal that determination to the Washington Superior Court or to the Superior
Court for the county in which the health insurer has a place of business. (Added 2013, No. 73, § 48.)