Code of Vermont Rules › Agency 21 - DEPARTMENT OF FINANCIAL REGULATION › Sub-Agency 020 - INSURANCE DIVISION › Chapter 073 - SELF-INSURED MULTIPLE EMPLOYER WELFARE ARRANGEMENTS AND ASSOCIATION HEALTH PLANS (I-2018-02) › Section 21 020 073 - SELF-INSURED MULTIPLE EMPLOYER WELFARE ARRANGEMENTS AND ASSOCIATION HEALTH PLANS (I-2018-02)

Current through June, 2024
Section 1 Purpose
This rule is promulgated pursuant to
				  8 V.S.A. §
											4079a and in response to the United States
				  Department of Labor's June 21, 2018 amendment to 29 C.F.R § 2510. See
				  Definition of "Employer" Under Section
				  3(5) of
				  ERISA--Association Health Plans, 83 Fed. Reg. 28,961 (June 21, 2018) (to be
				  codified at 29 C.F.R. § 2510.3-5 ). The purpose of this rule is to set
				  forth rules, forms, and procedures regarding self-insured association or MEWA
				  health plans. This rule protects Vermont consumers and promotes the stability
				  of Vermont's health insurance markets, to the extent permitted under federal
				  law, by implementing licensure, solvency, reserve, and rating requirements.
				  This rule shall not apply to association health plans that are fully funded.
				  Nothing in this rule shall be construed to provide a self-insured association
				  or MEWA, created pursuant to the Department of Labor's June 21, 2018 amendment
				  to 29 C.F.R § 2510, authority to operate in the State before January 1,
				  2019. Preexisting self-insured associations or MEWAs must come into compliance
				  with this rule no later than December 31, 2019.
Section 2 Definitions
The following terms are defined for purposes of this rule as
				  follows:
A. "Association" means any
				foreign or domestic association that provides a health benefit plan that covers
				the employees of at least one employer that is either domiciled in Vermont or
				has its principal headquarters or principal administrative office in Vermont.
				For purposes of this rule, "association" refers to self-insured associations,
				unless otherwise stated.
B.
				"Commissioner" means the Commissioner of the Vermont Department of Financial
				Regulation.
C. "Department" means
				the Vermont Department of Financial Regulation.
D. "Employee Welfare Benefit Plan," as used
				in this rule, has the same meaning as that contained in
				29
				U.S.C. §
											1002(1).
E. "Health Benefit Plan" means a policy,
				contract, certificate, or agreement offered or issued by a self-insured
				association or MEWA to provide, deliver, arrange for, pay for, or reimburse any
				of the costs of health services, as defined in
				33 V.S.A §
											1802(3).
F. "Multiple employer welfare arrangement
				(MEWA)," as used in this rule, has the same meaning as that contained in
				29
				U.S.C. §
											1002(40). For
				purposes of this rule, "multiple employer welfare arrangement (MEWA)" refers to
				self-insured associations, unless otherwise stated.
G. "Self-Insured" means any association or
				MEWA offering a health benefit plan that reimburses costs of health services
				incurred by covered persons pursuant to the benefits and coverages provided by
				their plan exclusively from association or MEWA assets.
H. "Third-party Administrator" means any
				person who, on behalf of an association or MEWA, receives or collects charges,
				contributions, or premiums for, or adjusts or settles claims on or for
				residents of this State or Vermont health care providers and facilities.