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NO. 43. AN ACT RELATING TO MEDICARE SUPPLEMENTAL INSURANCE.

(S.71)

It is hereby enacted by the General Assembly of the State of Vermont:

Sec. 1. 8 V.S.A. § 4062b is amended to read:

§ 4062b. MEDICARE SUPPLEMENTAL HEALTH INSURANCE

(a) Within five days of receiving a request for approval of any increased *[premium]* premiums in excess of $500,000.00, or any other coverage changes which the commissioner determines will have a comparable impact on cost or availability of coverage for a Medicare supplemental insurance policy issued by any group or nongroup health insurance company, hospital or medical service organization, or health maintenance organization, the commissioner shall notify the department of aging and disabilities of the proposed premium increase.

(b) Within five days after receiving notification pursuant to subsection (a) of this section, the department of aging and disabilities shall inform the members of the advisory board established pursuant to 33 V.S.A. § 505 of the proposed premium increase.

*[(c) The commissioner shall hold a public informational hearing regarding the proposed premium increase, if within ten days after the advisory board receives notice of the increase pursuant to subsection (b) of this section, 25 or more policy or certificate holders affected by the proposed increase or any organization that represents at least 25 affected policy or certificate holders requests such a hearing. The commissioner shall not approve any premium increase until after any informational hearing is held pursuant to this subsection.]*

(c)(1) The commissioner shall not approve any request to increase Medicare supplemental insurance premium rates unless the amount of the rate increase complies with the statutory standards for approval under sections 4062, 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 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 insurer, provided that the burden of proof shall be on the insurer to show that the approved rate does not meet the statutory standards established under this subsection.

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

(3) In reviewing any Medicare supplement rate increase for which an independent analysis has been performed pursuant to section 6706 of Title 33, the commissioner shall hold a public hearing where the insurer, the department 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. 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. In the commissioner's discretion the hearing may be conducted through interactive television.

(4) In any review held in accordance with this subsection, the commissioner shall permit intervention by any person that the commissioner determines will materially advance the interests of the insured individuals. The intervenor shall have access to, and may use the information of the independent expert appointed under section 6706 of Title 33. 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.

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

Sec. 2. 33 V.S.A. § 6706 is amended to read:

§ 6706. INDEPENDENT ANALYSIS

The commissioner of banking, insurance, securities, and health care administration shall adopt rules for the purposes of assuring an in-depth independent analysis by an expert, or experts, of proposed Medicare Supplement rate increases. This analysis shall be performed only when *[it]* the increased premiums requested exceed $500,000.00, or when the commissioner finds that the proposed premium and policy changes will have a comparable adverse impact on availability or cost of coverage, or when it otherwise appears to be in the best interest of the insureds *[and shall be made available to the public]*. The independent analyst shall be made available to the public during the analysis, and for the purpose of providing assistance with and testimony in connection with Medicare Supplement rate increase proposals. The cost for the analysis shall be assessed to the affected policy or certificate holders.

Approved: May 26, 1999