This Regulation sets forth Vermont's community rating methodology for registered small group carriers providing small group health plans to small groups; establishes the process for approval of community rates and methodology for small group carriers; proscribes underwriting standards for registered small group carriers.
This Rule is applicable only to provider sponsored organizations applying for licensure in Vermont that intend to offer solely Medicare+Choice program; adopts the solvency standards promulgated by the Health Care Financing Administration for purposes of the Medicare+Choice for provider sponsored organizations.
This regulation establishes standards for developing and implementing administrative, technical and physical safeguards to protect the security, confidentiality and integrity of customer information, consistent with sections 501, 505(b), and 507 of the Gramm-Leach-Bliley Act, codified at 15 U.S.C. 6801, 6805(b) and 6807 and 8 V.S.A. § § 15, 3568, 3688, 4812, 5111, and 8014.
This Rule sets forth the requirements for the submission of health care claims data, member eligibility data, and other information relating to health care provided to Vermont residents or by Vermont health care providers and facilities by health insurers, managed care organizations, third party administrators, pharmacy benefit managers, and others to the Department and conditions for the use and dissemination of such claims data, consistent with 18 V.S.A. § 9410.