Code of Vermont Rules › Agency 21 - DEPARTMENT OF FINANCIAL REGULATION › Sub-Agency 020 - INSURANCE DIVISION › Chapter 071 - FULLY-INSURED MULTIPLE EMPLOYER WELFARE ARRANGEMENTS AND ASSOCIATION HEALTH PLANS (I-2018-01) › Section 21 020 071 - FULLY-INSURED MULTIPLE EMPLOYER WELFARE ARRANGEMENTS AND ASSOCIATION HEALTH PLANS (I-2018-01)

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 fully-insured
				  association health plans. This rule protects Vermont consumers and promotes the
				  stability of Vermont's health insurance markets, to the extent permitted under
				  federal law, including rules regarding licensure, solvency, reserve
				  requirements, and rating requirements. This rule shall not apply to association
				  health plans that are self-funded. All associations and MEWAs must be in
				  compliance with this rule after September 1, 2018.
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.
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. "Fully Insured" means any association or
				MEWA health benefit plan coverage provided by a foreign or domestic insurer
				licensed to do business in Vermont and in compliance with
				8
				V.S.A. §§
											3368 and
				4079(2)
				and 29 U.S.C. §
											1144(b)(6)(D).
F. "Health Benefit Plan" means a policy,
				contract, certificate, or agreement offered or issued by a health insurer to
				provide, deliver, arrange for, pay for, or reimburse any of the costs of health
				services. The health benefit plan shall be issued to an association; to a
				trust; or to one or more trustees of a fund established, created, or maintained
				for the benefit of the members of one or more associations or a contract or
				plan issued by an association or trust or by a MEWA.
G. "Insurer" means any insurer, nonprofit
				hospital or medical service corporation, health maintenance organization, or
				managed care organization offering health insurance as defined in
				8 V.S.A. §
											3301(a)(2). An insurer shall
				not offer a health benefit plan to an association or MEWA with covered lives in
				Vermont unless it possesses a certificate of authority from the
				Commissioner.
H. "Multiple employer
				welfare arrangement (MEWA)," as used in this rule, has the same meaning as that
				contained in
				29
				U.S.C. §
											1002(40).