Code of Vermont Rules › Agency 21 - DEPARTMENT OF FINANCIAL REGULATION › Sub-Agency 020 - INSURANCE DIVISION › Chapter 029 - REGULATION 91-b4, MINIMUM REQUIREMENTS FOR COMPLIANCE WITH 8 V.S.A. SECITON 4080a (SMALL GROUP CARRIERS) › Section 21 020 029 - REGULATION 91-b4, MINIMUM REQUIREMENTS FOR COMPLIANCE WITH 8 V.S.A. SECITON 4080a (SMALL GROUP CARRIERS)

Current through June,
				2024
Section 1 PURPOSE
The purpose of this regulation is to set forth the rules for
				  registration of small group carriers, requirements for the sale of individual
				  insurance and the standards and process for approval of common health care
				  plans.
Section 2 AUTHORITY
This regulation is issued pursuant to the authority vested in
				  the Commissioner of the Department of Banking, Insurance and Securities
				  ("Commissioner") by Title
				  8 V.S.A., Section
				  4080a.
Section 3 REGISTRATION
No person may offer a small group plan unless such person is
				  a registered small group carrier as defined by
				  8 V.S.A. Section
				  4080a(a)(4). Pursuant to 8
				  V.S.A. 4080a(c) the following are the minimum requirements for registration as
				  a small group carrier:
1. The carrier
				must apply to the Commissioner to be a registered small group
				carrier.
2. The carrier must be
				licensed or authorized to provide health insurance in Vermont.
3. The carrier shall have all small group
				rates, common health care plans and forms approved by the Department of
				Banking, Insurance and Securities ("Department") prior to their use in
				Vermont.
4. The carrier must have
				licensed or employee sales representatives in Vermont.
5. The carrier must designate, in writing,
				the name and address of a representative responsible for answering questions
				and responding to complaints about underwriting and claims.
6. The carrier must provide insureds with a
				toll free number for claims handling and customer service.
7. All advertising material about small group
				insurance must clearly identify the product advertised as a "Small Group Health
				Insurance Plan." All advertising material must be filed with the Department of
				Banking, Insurance and Securities prior to use.
8. The carrier must provide access to prior
				group experience, including gross premium (gross premium means written direct
				premium) earned premium and incurred claims, if collected, upon written request
				from any group policyholder.
9. The
				carrier must file annually the following information with the Department for
				the preceding calendar year no later than April 1:
a. the number of employers covered under each
				small group plan;
b. the number of
				employees and an estimate of the number of lives covered under each small group
				plan;
c. the gross premium for each
				small group plan;
d. the earned
				premium for each small group plan;
e. the incurred claims for each small group
				plan;
f. the number of employers
				with rates deviating above and below the community rate for each small group
				plan;
g. the amount of gross
				premium above, below and at the community rate for each small group plan;
				and
h. the same information
				required in lines a-g must be provided for any business underwritten with or
				through an association or trust, to include the name and address of each
				association or trust.
10.
				A carrier who intends to withdraw from the small group market must notify the
				Commissioner in writing at least six (6) months prior to canceling or
				nonrenewing any coverage. This notice must include the following information:
a. a description of the plans offered by the
				carrier;
b. the number of employers
				and the total number of lives insured under each contract; and
c. the planned termination date(s).
11. A registered carrier who
				qualifies under the provisions of Section
				6(c),
				1991, Act 52 must certify in writing by April 1 of each year that it continues
				to qualify and that in the preceding calendar year it has not written more than
				$ 100,000.00 in annual gross premium for small group business covering
				individuals residing in this state.