About Vermont’s Health Insurance Rate Review Process
The State of Vermont regulates health insurance rates to ensure that Vermonters pay a fair price for quality coverage. The process also examines whether insurance companies have sufficient assets to run their business and to pay for the medical claims of their policyholders. In addition to having the primary responsibility for reviewing rate requests for comprehensive major medical health insurance plans, the Green Mountain Care Board (GMCB) regulates hospital budgets and major capital expenditures, taking a broad view of the many factors that influence the affordability, accessibility, and quality of Vermonters’ health care.
How Rates Are Reviewed
Filing
The process begins when an insurance carrier submits a filing to the GMCB. The filing often requests a change in the rates charged for a particular health insurance plan offered to Vermonters.
The GMCB posts new rate requests on its website within five days of receiving the filing. Anyone who wishes to receive automatic alerts about new filings to the GMCB may do so by first clicking on the "View Filings" tab on the left, and then signing up for the "RSS Feed"* on one or all of the insurers' individual "Pending Reviews" or "Decisions" web pages.
The insurance company applying to have its rate request approved by the Board is a party to the formal rate review filing. Vermont’s Office of Health Care Advocate, a division of Vermont Legal Aid, may also choose to participate as a party representing Vermont health care consumers. In addition, a person may qualify as an interested party if he or she can demonstrate a direct and substantial effect from the outcome of the review.
Public Comment
Once a rate filing is posted on GMCB’s website, a public comment period begins. Anyone who wishes to post a comment or question about the filing may do so on the web, on the phone, or by mail by following the directions on the Public Comment page.
Public comment extends for 15 days after the GMCB makes all required postings to its website, as explained below.
Opinions
Within 60 days of the its receipt of a rate filing, the GMCB must post on its website the opinion of an actuary discussing the reasonableness of the rate change, and the opinion of Vermont’s Department of Financial Regulation (DFR) regarding the impact of the requested rate change on the solvency of the health insurance carrier named in the filing.
Within 30 days of posting these two opinions, the GMCB will hold a public hearing on the filing.
Decision
The GMCB decides to approve, modify, or disapprove a rate request within 90 days from the date it was filed. This decision is posted on the website. A party may appeal to the Vermont Supreme Court within 30 days of the decision.
For more information about the Rate Review process, visit Title 8, Chapter 107 of the Vermont Statutes, and the GMCB's Rule 2.00 (Health Insurance Rate Review).
* RSS (Really Simple Syndication) is a standard way to share frequently updated information on the Internet and requires (1) a feed reader, and (2) an RSS feed. There are many feed readers available, including ones built into newer versions of Internet Explorer and Outlook; just follow the setup instructions for the specific software that you choose. To add the RSS feed to your reader, click on the small orange square next to the RSS link. Once you have both reader and feed, the reader will automatically keep track of updates which you can view by clicking on the reader. You can also join a service that sends you an email whenever the feed is updated if you prefer to get notification via email.