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BILL AS INTRODUCED 2007-2008

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S.95

Introduced by Senator Cummings of Washington District

Referred to Committee on

Date:

Subject:  Health; Catamount Health; Vermont health access plan; small business; eligibility  

Statement of purpose:  This bill proposes to allow access to Catamount Health and the Vermont health access plan for small businesses and their employees without a 12-month waiting period.

AN ACT RELATING TO SMALL BUSINESS ELIGIBILITY FOR CATAMOUNT HEALTH AND VHAP

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

Sec. 1.  8 V.S.A. § 4080f(a)(9) is amended to read:

(a)  As used in this section:

* * *

(9)  “Small business” means an entity employing three full‑time equivalent employees or fewer.

(9)(10)  “Uninsured” means an individual who does not qualify for Medicare, Medicaid, the Vermont health access plan, or Dr. Dynasaur, and had no private insurance or employer‑sponsored coverage that includes both hospital and physician services within 12 months prior to the month of application, is employed by a small business, is self‑employed, or lost private insurance or employer‑sponsored coverage during the prior 12 months for the following reasons:

(A)  the individual’s private insurance or employer‑sponsored coverage ended because of:

(i)  loss of employment, unless the employer has terminated its employees for the primary purpose of discontinuing employer‑sponsored coverage and establishing their eligibility for Catamount Health;

(ii)  death of the principal insurance policyholder;

(iii)  divorce or dissolution of a civil union;

(iv)  no longer qualifying as a dependent under the plan of a parent or caretaker relative; or

(v)  no longer qualifying for participating in COBRA, VIPER, or other state continuation coverage; or

(B)  college‑ or university‑sponsored health insurance became unavailable to the individual because the individual graduated, took a leave of absence, or otherwise terminated studies.

Sec. 2.  33 V.S.A. § 1971 is amended to read:

§ 1971.  Definitions

As used in this subchapter,:

(1)  “Agency” means the agency of human services.

(2)  “Secretary” means the secretary of human services.

(3)  “Office of Vermont health access” means the office administering the Medicaid program for the agency of human services and includes the managed care organization established in section 1901 of this title.

(3)  “Secretary” means the secretary of human services.

(4)  “Small business” means an entity employing three full‑time equivalent employees or fewer.

Sec. 3.  33 V.S.A. § 1973 is amended to read:

§ 1973.  VERMONT HEALTH ACCESS PLAN

(a)  The agency of human services or its designee shall establish the Vermont health access plan (VHAP) pursuant to a waiver of federal Medicaid law.  The plan shall remain in effect as long as a federal 1115 demonstration waiver is granted or renewed.

(b)  The purpose of the Vermont health access plan is to provide health care coverage for uninsured or underinsured low income Vermonters.  The agency of human services or its designee shall establish rules regarding eligibility and administration of the plan.  The agency shall not require employees of a small business as defined in subdivision 1971(4) of this title or a self‑employed individual to be uninsured to qualify for coverage under this section.


Sec. 4.  33 V.S.A. § 1974(c)(1)(B) is amended to read:

(B)  “Small business” means an entity employing three full‑time equivalent employees or fewer.

(B)(C)  “Uninsured” means an individual who does not qualify for Medicare, Medicaid, the Vermont health access plan, or Dr. Dynasaur and had no private insurance or employer‑sponsored coverage that includes both hospital and physician services within 12 months prior to the month of application, is employed by a small business, is self‑employed, or lost private insurance or employer‑sponsored coverage during the prior 12 months for the following reasons:

(i)  the individual’s coverage ended because of:

(I)  loss of employment;

(II)  death of the principal insurance policyholder;

(III)  divorce or dissolution of a civil union;

(IV)  no longer qualifying as a dependent under the plan of a parent or caretaker relative; or

(V)  no longer qualifying for participating in COBRA, VIPER, or other state continuation coverage; or

(ii)  college‑ or university‑sponsored health insurance became unavailable to the individual because the individual graduated, took a leave of absence, or otherwise terminated studies.

Sec. 5.  33 V.S.A. § 1982(2) is amended to read:

(2)  “Small business” means an entity employing three full‑time equivalent employees or fewer.

(3)  “Uninsured” means an individual who does not qualify for Medicare, Medicaid, the Vermont health access plan, or Dr. Dynasaur and had no private insurance or employer‑sponsored coverage that includes both hospital and physician services within 12 months prior to the month of application, is employed by a small business, is self‑employed, or lost private insurance or employer‑sponsored coverage during the prior 12 months for the following reasons:

(A)  the individual’s private insurance or employer‑sponsored coverage ended because of:

(i)  loss of employment;

(ii)  death of the principal insurance policyholder;

(iii)  divorce or dissolution of a civil union;

(iv)  no longer qualifying as a dependent under the plan of a parent or caretaker relative; or

(v)  no longer qualifying for participating in COBRA, VIPER, or other state continuation coverage; or

(B)  college‑ or university‑sponsored health insurance became unavailable to the individual because the individual graduated, took a leave of absence, or otherwise terminated studies.



Published by:

The Vermont General Assembly
115 State Street
Montpelier, Vermont


www.leg.state.vt.us