§ 1805. Duties and responsibilities

The Vermont Health Benefit Exchange shall have the following duties and responsibilities consistent with the Affordable Care Act:

(1) offering coverage for health services through qualified health benefit plans, including by creating a process for:

(A) the certification, decertification, and recertification of qualified health benefit plans as described in section 1806 of this title;

(B) enrolling qualified individuals in qualified health benefit plans, including through open enrollment periods as provided in the Affordable Care Act, and ensuring that individuals may transfer coverage between qualified health benefit plans and other sources of coverage as seamlessly as possible; and

(C) creating a simplified and uniform system for the administration of health benefits;

(2) determining eligibility for and enrolling individuals in Medicaid, Dr. Dynasaur, and VPharm pursuant to chapter 19 of this title, as well as any other public health benefit program;

(3) creating and maintaining consumer assistance tools, including a website through which enrollees and prospective enrollees of qualified health benefit plans may obtain standardized comparative information on such plans, a toll-free telephone hotline to respond to requests for assistance, and interactive online communication tools, in a manner that complies with the Americans with Disabilities Act;

(4) creating standardized forms and formats for presenting health benefit options in the Vermont Health Benefit Exchange, including the use of the uniform outline of coverage established under Section 2715 of the federal Public Health Services Act;

(5) assigning a quality and wellness rating to each qualified health benefit plan offered through the Vermont Health Benefit Exchange and determining each qualified health benefit plan‘s level of coverage in accordance with regulations issued by the U.S. Department of Health and Human Services;

(6) determining enrollee subsidies as required by the Secretary of the U.S. Department of the Treasury or of the U.S. Department of Health and Human Services and informing consumers of eligibility for subsidies, including by providing an electronic calculator to determine the actual cost of coverage after application of any premium tax credit under Section 36B of the Internal Revenue Code of 1986 and any cost-sharing reduction under Section 1402 of the Affordable Care Act;

(7) transferring to the Secretary of the U.S. Department of the Treasury the name and taxpayer identification number of each individual who was an employee of an employer but who was determined to be eligible for the premium tax credit under Section 36B of the Internal Revenue Code of 1986 for the following reasons:

(A) the employer did not provide minimum essential coverage; or

(B) the employer provided the minimum essential coverage, but it was determined under Section 36B(c)(2)(C) of the Internal Revenue Code to be either unaffordable to the employee or not to provide the required minimum actuarial value;

(8) performing duties required by the Secretary of the U.S. Department of Health and Human Services or the Secretary of the U.S. Department of the Treasury related to determining eligibility for the individual responsibility requirement exemptions, including:

(A) granting a certification attesting that an individual is exempt from the individual responsibility requirement or from the penalty for violating that requirement, if there is no affordable qualified health benefit plan available through the Vermont Health Benefit Exchange or the individual’s employer for that individual or if the individual meets the requirements for any exemption from the individual responsibility requirement or from the penalty pursuant to Section 5000A of the Internal Revenue Code of 1986; and

(B) transferring to the Secretary of the U.S. Department of the Treasury a list of the individuals who are issued a certification under subdivision (8)(A) of this section, including the name and taxpayer identification number of each individual;

(9)(A) transferring to the Secretary of the U.S. Department of the Treasury the name and taxpayer identification number of each individual who notifies the Vermont Health Benefit Exchange that he or she has changed employers and of each individual who ceases coverage under a qualified health benefit plan during a plan year and the effective date of that cessation; and

(B) communicating to each employer the name of each of its employees and the effective date of the cessation reported to the U.S. Department of the Treasury under this subdivision;

(10) establishing a navigator program as described in section 1807 of this title;

(11) reviewing the rate of premium growth within and outside the Vermont Health Benefit Exchange;

(12) [Repealed.]

(13) providing consumers and health care professionals with satisfaction surveys and other mechanisms for evaluating the performance of qualified health benefit plans and informing the Commissioner of Vermont Health Access and the Commissioner of Financial Regulation of such performance;

(14) ensuring consumers have easy and simple access to the relevant grievance and appeals processes pursuant to 8 Vt. Stat. Ann. chapter 107 and 3 V.S.A. § 3090 (Human Services Board);

(15) consulting with the Advisory Committee established in section 402 of this title to obtain information and advice as necessary to fulfill the duties outlined in this subchapter;

(16) referring consumers to the Office of the Health Care Advocate for assistance with grievances, appeals, and other issues involving the Vermont Health Benefit Exchange; and

(17) establishing procedures, including payment mechanisms and standard fee or compensation schedules, that allow licensed insurance agents and brokers to be appropriately compensated outside the navigator program established in section 1807 of this title for:

(A) assisting with the enrollment of qualified individuals and qualified employers in any qualified health plan offered through the Exchange for which the individual or employer is eligible; and

(B) assisting qualified individuals in applying for premium tax credits and cost-sharing reductions for qualified health benefit plans purchased through the Exchange. (Added 2011, No. 48, § 4; amended 2011, No. 78 (Adj. Sess.), § 2, eff. April 2, 2012; 2011, No. 171 (Adj. Sess.), § 2d; 2013, No. 79, § 29, eff. Oct. 1, 2013; 2013, No. 79, § 35g, eff. January 1, 2014; 2021, No. 74, § E.306.1, eff. Oct. 1, 2021.)