8 V.S.A. § 4051: Medicare supplement insurance policies [Effective until January 1, 2026; see also 8 V.S.A. § 4051 effective January 1, 2026 set out below]

(a) Community rating.

(1) A health insurer shall use a community rating method acceptable to the Commissioner for determining premiums for Medicare supplement insurance policies.

(2) The Commissioner shall adopt rules for standards and procedure for permitting health insurers that issue Medicare supplement insurance policies to use one or more risk classifications in their community rating method. The premium charged shall not deviate from the community rate and the rules shall not permit medical underwriting and screening, except that a health insurer may set different community rates for persons eligible for Medicare by reason of age and persons eligible for Medicare by reason of disability.

(b) Premium increases.

(1) Within five days after receiving a request for approval of any composite average rate increase in excess of three percent, or any other coverage changes that the Commissioner determines will have a comparable impact on cost or availability of coverage for a Medicare supplement insurance policy issued by any health insurer with 5,000 or more total lives in the Vermont Medicare supplement insurance market, the Commissioner shall notify the Department of Disabilities, Aging, and Independent Living of the proposed premium increase. A composite average rate is the enrollment-weighted average rate increase of all plans offered by a health insurer.

(2) Within five days after receiving notification pursuant to subdivision (1) of this subsection, the Department of Disabilities, Aging, and Independent Living shall inform the members of the Advisory Board established pursuant to 33 V.S.A. § 505 of the proposed premium increase.

(3)(A) The Commissioner shall not approve any request to increase Medicare supplement insurance premium rates unless the amount of the rate increase complies with the statutory standards for approval under sections 4026, 4513, 4584, and 5104 of this title. Any approved rate increase shall not be based on an unreasonable change in loss ratio from the previous year, unless the Commissioner makes written findings that such change is necessary to prevent a substantial adverse impact on the financial condition of the health insurer. In acting on such rate increase requests, the Commissioner may deny the request, approve the rate increase as requested, or approve a rate increase in an amount different from the increase requested. A decision by the Commissioner other than an approval of the rate requested may be appealed by the health insurer, provided that the burden of proof shall be on the health insurer to show that the approved rate does not meet the statutory standards established under this subsection.

(B) Before acting on the rate increase requested, the Commissioner may make such examination or investigation as the Commissioner deems necessary, including where applicable the review process set forth in subdivision (C) of this subdivision (3).

(C)(i) In reviewing any Medicare supplement insurance rate increase for which an independent analysis has been performed pursuant to 33 V.S.A. § 6706 and in which the health insurer’s requested composite average increase, the independent expert’s recommended composite average rate increase, or the Department actuary’s recommended composite average rate increase differ by two percentage points or more, the Commissioner shall hold a public hearing at which the health insurer, the Department’s actuary, the independent expert, any intervenor, and the public will have the opportunity to present written and oral testimony and will be available to answer questions of the Commissioner and those present.

(ii) The hearing shall be noticed and held at a time and place so as to facilitate public participation and shall be recorded and become part of the record before the Commissioner. At the Commissioner’s discretion, the hearing may be conducted remotely.

(iii) If the carrier’s requested composite average increase, the independent expert’s recommended composite average increase, or the Department actuary’s recommended composite average increase differs by less than two percentage points, the Department and the parties shall confer by conference call, or by any other available media, to review the rate requests and recommendations. However, a public hearing may be held at the Commissioner’s discretion for good cause shown.

(D)(i) In any review held in accordance with this subdivision (3), the Commissioner shall permit intervention by any person whom the Commissioner determines will materially advance the interests of the covered individuals. The intervenor shall have access to and may use the information of the independent expert appointed under 33 V.S.A. § 6706.

(ii) The reasonable and necessary cost of intervention as determined by the Commissioner shall be paid by the affected policyholders or certificate holders. The maximum payment shall be $2,500.00 except when waived by the Commissioner for good cause shown. The $2,500.00 maximum amount may be adjusted to reflect, at the Commissioner’s discretion, appropriate inflation factors.

(E) Nonproprietary, relevant information in any Medicare supplement insurance rate filing, including any analysis by the Department’s actuary and the independent expert, shall be made available to the public upon request.

(c) Disability.

(1) A health insurer that issues Medicare supplement insurance policies or certificates to a person eligible for Medicare by reason of age shall make available, to persons eligible for Medicare by reason of disability, the same policies or certificates that are offered and sold to persons eligible for Medicare by reason of age. The initial enrollment period for any such policies or certificates shall be at least six months following the date the individual becomes eligible for Medicare by reason of disability. Any additional enrollment periods as required by law and offered to individuals eligible by reason of age shall be offered to individuals eligible by reason of disability.

(2) This subsection does not apply to persons eligible for Medicare by reason of end stage renal disease.

(d) Outreach and education. The Department of Financial Regulation shall collaborate with health insurers, advocates for older Vermonters and for other Medicare-eligible adults, and the Office of the Health Care Advocate to educate the public about the benefits and limitations of Medicare supplement insurance policies and Medicare Advantage plans, including information to help the public understand issues relating to coverage, costs, and provider networks. (Recodified and amended 2025, No. 11, § 2, eff. September 1, 2025.)