§ 4584. Application for permit

(a) A corporation incorporated under this chapter shall immediately, after filing its articles of association, apply to the Commissioner of Financial Regulation for a permit to operate. The application shall be made to the Commissioner upon forms to be prescribed by the Commissioner. The application shall include a statement of the territory in which the corporation proposed to operate, the services to be furnished and rendered by it, and the rates to be charged for those services. The application shall be accompanied by two copies of any contract for medical services that the corporation proposes to make with its subscriber. Before issuing the permit, the Commissioner may make such examination or investigation as the Commissioner deems necessary. The Commissioner may refuse the permit if the Commissioner finds that the rates submitted are excessive, inadequate, or unfairly discriminatory.

(b) A corporation organized under the provisions of this chapter shall not enter into a contract with a subscriber to furnish medical services until it has obtained from such Commissioner a permit to do so.

(c) In connection with a rate decision, the Green Mountain Care Board may also make reasonable supplemental orders to the corporation and may attach reasonable conditions and limitations to such orders as the Board finds, on the basis of competent and substantial evidence, necessary to ensure that benefits and services are provided at minimum cost under efficient and economical management of the corporation. The Commissioner and, except as otherwise provided by 18 V.S.A. §§ 9375 and 9376, the Green Mountain Care Board, shall not set the rate of payment or reimbursement made by the corporation to any physician, hospital, or other health care provider.

(d) The Commissioner shall permit rates for a medical service corporation designed to enable the corporation to accumulate and maintain a reserve fund that shall from time to time during the calendar year be increased in an amount equal to at least two percent of the annual premium income of the corporation until the reserve fund is equal to at least eight percent of the annual premium income of the corporation. However, if the liabilities of the corporation exceed its assets, the Commissioner shall permit the corporation to charge rates that enable the corporation to accumulate a reserve fund at the rate of at least five percent of annual premium income of the corporation until the corporation’s assets equal its liabilities. Nothing in this subchapter shall require the Commissioner to permit a corporation to accumulate a reserve fund until the law of the state of incorporation of that corporation is substantially similar to this subsection with respect to the reserve fund. (Amended 1975, No. 69, § 4, eff. April 18, 1975; 1989, No. 225 (Adj. Sess.), § 25; 1995, No. 180 (Adj. Sess.), § 38; 2011, No. 78 (Adj. Sess.), § 2, eff. April 2, 2012; 2013, No. 79, § 5i, eff. Jan. 1, 2014; 2021, No. 105 (Adj. Sess.), § 214, eff. July 1, 2022.)