The Vermont Statutes Online

Title 33 : Human Services

Chapter 018 : Public-Private Universal Health Care System

Subchapter 001 : VERMONT HEALTH BENEFIT EXCHANGE

• § 1803. Vermont Health Benefit Exchange

  (a)(1) The Department of Vermont Health Access shall establish the Vermont Health Benefit Exchange, which shall be administered by the Department in consultation with the Advisory Committee established in section 402 of this title.

  (2) The Vermont Health Benefit Exchange shall be considered a division within the Department of Vermont Health Access and shall be headed by a Deputy Commissioner as provided in 3 V.S.A. chapter 53.

  (b)(1)(A) The Vermont Health Benefit Exchange shall provide qualified individuals and qualified employers with qualified health benefit plans, including the multistate plans required by the Affordable Care Act, with effective dates beginning on or before January 1, 2014. The Vermont Health Benefit Exchange may contract with qualified entities or enter into intergovernmental agreements to facilitate the functions provided by the Vermont Health Benefit Exchange.

  (B) Prior to contracting with any health insurer, the Vermont Health Benefit Exchange shall consider the insurer’s historic rate increase information required under section 1806 of this title, along with the information and the recommendations provided to the Vermont Health Benefit Exchange by the Commissioner of Financial Regulation under Section 2794(b)(1)(B) of the federal Public Health Service Act.

  (2) To the extent allowable under federal law, the Vermont Health Benefit Exchange may offer health benefits to populations in addition to those eligible under Subtitle D of Title I of the Affordable Care Act, including:

  (A) to individuals and employers who are not qualified individuals or qualified employers as defined by this subchapter and by the Affordable Care Act;

  (B) Medicaid benefits to individuals who are eligible, upon approval by the Centers for Medicare and Medicaid Services and provided that including these individuals in the Health Benefit Exchange would not reduce their Medicaid benefits;

  (C) Medicare benefits to individuals who are eligible, upon approval by the Centers for Medicare and Medicaid Services and provided that including these individuals in the Health Benefit Exchange would not reduce their Medicare benefits; and

  (D) State employees and municipal employees, including teachers.

  (3) To the extent allowable under federal law, the Vermont Health Benefit Exchange may offer health benefits to employees for injuries arising out of or in the course of employment in lieu of medical benefits provided pursuant to 21 V.S.A. chapter 9 (workers’ compensation).

  (4) To the extent permitted by the U.S. Department of Health and Human Services, the Vermont Health Benefit Exchange shall permit qualified individuals and qualified employers to purchase qualified health benefit plans through the Exchange website, through navigators, by telephone, or directly from a health insurer under contract with the Vermont Health Benefit Exchange.

  (c)(1) The Vermont Health Benefit Exchange may determine an appropriate method to provide a unified, simplified administration system for health insurers offering qualified health benefit plans. The Exchange may include claims administration, benefit management, billing, or other components in the unified system and may achieve simplification by contracting with a single entity for administration and management of all qualified health benefit plans, by licensing or requiring the use of particular software, by requiring health insurers to conform to a standard set of systems and rules, or by another method determined by the Commissioner.

  (2) The Vermont Health Benefit Exchange may offer certain services, such as wellness programs and services designed to simplify administrative processes, to health insurers offering plans outside the Exchange, to workers’ compensation insurers, to employers, and to other entities.

  (d) The Vermont Health Benefit Exchange may enter into information-sharing agreements with federal and State agencies and other state exchanges to carry out its responsibilities under this subchapter, provided such agreements include adequate protections with respect to the confidentiality of the information to be shared and provided such agreements comply with all applicable State and federal laws and regulations. (Added 2011, No. 48, § 4; amended 2013, No. 144 (Adj. Sess.), § 2, eff. May 27, 2014; 2015, No. 54, § 11, eff. June 5, 2015.)