§ 1802. Definitions

As used in this subchapter:

(1) “Affordable Care Act” means the federal Patient Protection and Affordable Care Act, Pub. L. No. 111-148, as amended by the federal Health Care and Education Reconciliation Act of 2010, Pub. L. No. 111-152, and as further amended.

(2) “Commissioner” means the Commissioner of Vermont Health Access.

(3) “Health benefit plan” means a policy, contract, certificate, or agreement offered or issued by a health insurer to provide, deliver, arrange for, pay for, or reimburse any of the costs of health services. This term does not include coverage only for accident or disability income insurance, liability insurance, coverage issued as a supplement to liability insurance, workers’ compensation or similar insurance, automobile medical payment insurance, credit-only insurance, coverage for on-site medical clinics, or other similar insurance coverage where benefits for health services are secondary or incidental to other insurance benefits as provided under the Affordable Care Act. The term also does not include stand-alone dental or vision benefits; long-term care insurance; short-term, limited-duration health insurance; specific disease or other limited benefit coverage, Medicare supplemental health benefits, Medicare Advantage plans, and other similar benefits excluded under the Affordable Care Act.

(4) “Health insurer” shall have the same meaning as in 18 V.S.A. § 9402.

(5) “Qualified employer”:

(A) means an entity that employed an average of not more than 50 employees on working days during the preceding calendar year and that:

(i) has its principal place of business in this State and elects to provide coverage for its eligible employees through the Vermont Health Benefit Exchange, regardless of where an employee resides; or

(ii) elects to provide coverage through the Vermont Health Benefit Exchange for all of its eligible employees who are principally employed in this State;

(B) on and after January 1, 2016, shall include an entity that:

(i) employed an average of not more than 100 employees on working days during the preceding calendar year; and

(ii) meets the requirements of subdivisions (A)(i) and (A)(ii) of this subdivision (5).

(C) [Repealed.]

(6) “Qualified entity” means an entity with experience in individual and group health insurance, benefit administration, or other experience relevant to health benefit program eligibility, enrollment, or support.

(7) “Qualified health benefit plan” means a health benefit plan that meets the requirements set forth in section 1806 of this title.

(8) “Qualified individual” means an individual, including a minor, who is a Vermont resident and, at the time of enrollment:

(A) is not incarcerated, or is only incarcerated awaiting disposition of charges; and

(B) is, or is reasonably expected to be during the time of enrollment, a citizen or national of the United States or an immigrant lawfully present in the United States as defined by federal law.

(9) “Modified adjusted gross income” shall have the same meaning as in 26 U.S.C. § 36B(d)(2)(B).

(10) “Reflective health benefit plan” means a health benefit plan that meets the requirements set forth in section 1813 of this title. (Added 2011, No. 48, § 4; amended 2011, No. 171 (Adj. Sess.), § 1; 2013, No. 50, § E.307, eff. Oct. 1, 2013; 2015, No. 54, § 13, eff. June 5, 2015; 2015, No. 151 (Adj. Sess.), § 1. 2018; 2017, No. 88 (Adj. Sess.), § 2, eff. Feb. 20, 2018; 2017, No. 131 (Adj. Sess.), § 5, eff. May 16, 2018; 2019, No. 19, § 4, eff. Jan. 1, 2020.)