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Background

• Vermont created a health care program through the Health Care Affordability Act called Catamount Health for uninsured persons who are not covered by Medicare, Medicaid and related programs, 8 Vt. Code R. § 4080f (external link).  The legislature sought to control health care costs by managing patients’chronic care to avoid more expensive treatments and make health care affordable and accessible to all residents, 2006 Health Care Reform Initiatives—The Details (external link).  Central to the state legislation was the creation of a pool of the uninsured into a single market.  This included those that did not have insurance for at least 12 months. 8 Vt. Code R. § 4080f(a)(9) (external link).
• Under the Vermont Act, Catamount Health providers operate like a traditional insurance program, though deductibles and co-payments are set by law.  Catamount Health insurers prohibits classifying individuals by risk classification factors such as race, gender or medical underwriting and screening.  Instead, healthy and unhealthy participants are pooled according to a community rating system, reducing costs by spreading risks over a broader segment of the population 8 Vt. Code R. § 4080f(j) & Department of Banking, Insurance, Securities & Health Care Administration, Health Care Administration Regulations, Regulation H-99-4 (external link).
• Catamount Health is funded through enrollee premiums, state and federal funding, employer assessments, and tobacco taxes. 2006 Health Care Reform Initiatives—The Details (external link).

Coverage

• Maximum deductible, coinsurance, copayments and out-of-pocket expenses. 8 Vt. Code R. § 4080f(c)(1) (external link).
• A prescription drug benefit with capped deductibles and copayments. 8 Vt. Code R. § 4080f(c)(1)(D) (external link).
• Preventative care visits, such as a mammograms or “preventative recommended services for chronic illness, such as eye exams for people with diabetes” are provided at no cost.  The Health Care Affordability Act; H.861 Committee of Conference – May 5, 2006.

Employer Contribution

• Employers are charged a Health Care Fund Contribution Assessment for a certain number of full time employees who are not covered by health insurance.  21 Vt. Code R. § 2003 (external link).

Individual Contribution

• Participants with incomes at or below 300% of the Federal Poverty Level can receive premium assistance based on a sliding scale based on income.  8 Vt. Code R. § 4080f(d)(2)(A) (external link) & 2006 Health Care Reform Initiatives—The Details (external link).
• Uninsured employees can also receive assistance to pay for costs to participate in employer sponsored plans. 33 Vt. Code R. § 1974 (external link) & 2006 Health Care Reform Initiatives—The Details (external link).

For more information on Vermont see:

• Guide to Law Online: Vermont

Last Updated: 02/28/2014