Green Mountain Care Board explains rate-review process for fully insured health plans

Michael Barber, general counsel to the Green Mountain Care Board, outlined the board’s rate-review program and the steps used to evaluate premiums for fully insured health insurance plans.

The rate-review process matters because it scrutinizes insurer requests that directly affect premiums paid by Vermonters in the individual and small-group markets and informs whether proposed increases are modified before plans reach consumers.

Barber said the board reviews “fully insured major medical health insurance plans,” commonly called comprehensive coverage, across three markets: individual, small-group and large-group. He noted the board does not review self-insured employer plans, Medicare (including Medicare Advantage and Medicare supplemental plans), Medicaid, workers’ compensation plans or limited-benefit and other specialty plans.

Barber provided recent review statistics: in the prior year the board reviewed 10 rate filings covering about $810,000,000 in premiums for roughly 82,000 people, more than…