State Codes and Statutes
Statutes > Vermont > Title-08 > Chapter-107 > 4080c
§ 4080c. Health insurance safety net
(a) Upon payment of the required premium, the secretary of administration shall make health insurance available for the following:
(1) Individuals in the nongroup market as of April 1, 1992 and individuals in the small group market as of July 1, 1992 who lose coverage for any of the following reasons:
(A) Their insurer withdraws from the marketplace in Vermont.
(B) Their insurer fails to register as of July 1, 1993 as a carrier qualified to provide nongroup insurance coverage.
(2) Individuals in the group market who are terminated, laid off or otherwise separated from employment and who are not subsequently covered or eligible for coverage under another group health insurance plan. Eligibility for coverage under this subdivision shall commence at the end of any health insurance continuation right provided by state or federal law.
(b) Notwithstanding any provision of law to the contrary, coverage under this section shall be offered by nonprofit hospital and medical service corporations chartered in Vermont pursuant to chapters 123 and 125 of Title 8 at substantially similar terms and prices for the period beginning April 1, 1992 and ending when universal access is implemented by the general assembly. The secretary may make coverage available under this section from any other insurer or health maintenance organization licensed to do business in Vermont. The provisions of section 5115 of this title, relating to the duty of health maintenance organizations, shall not apply to coverage made available under this section. No person may offer a health benefit plan or insurance policy under this section as a means of circumventing the requirements of section 4080b of this title, and the commissioner shall adopt, by rule, standards and a process to carry out the provisions of this prohibition.
(c) The term "substantially similar terms" shall not be construed to prohibit policy terms which are different, but not less comprehensive in scope of coverage than those contained in policies previously covering individuals qualifying for coverage under this section. "Substantially similar prices" mean prices which are identical to the costs paid by such individuals during the preceding year, adjusted by medical inflation costs not to exceed 15 percent. Any entity providing insurance under this section shall be entitled to rate adjustments of up to 15 percent per year on their risks covered under this health insurance safety net provided they have a loss ratio for such business of at least 80 percent; provided that the commissioner may grant an increase that exceeds 15 percent if the commissioner determines that the 15 percent limitation will have a substantial adverse effect on the financial safety and soundness of the insurer. For the purposes of this section, "loss ratio" shall mean a comparison of earned premiums to losses incurred.
(d) Any surplus income realized by a carrier through participation in the program established by this section shall be applied to reduce or mitigate increases in premiums paid by other nongroup policyholders. As used in this subsection, "surplus income" means a carrier's premium income, less the carrier's claims paid and incurred and the carrier's reasonable administrative costs of no more than eight percent. (Added 1991, No. 160 (Adj. Sess.), § 42, eff. May 11, 1992.)
