Third Party Administrator (TPA) Registration

Under Vermont laws and regulations, TPAs are required to complete a VHCURES and TPA registration on an annual basis. The instructions below will guide registrants to the consolidated on-line registration form designed to support VHCURES and TPA registration on a single form.

Any person who on behalf of a health insurer or purchaser of health benefits receives or collects charges, contributions or premiums for, or adjusts or settles claims on or for residents of Vermont or Vermont health care providers and facilities shall register with the State of Vermont, both before doing business in Vermont and on an annual basis prior to December 31 thereafter. See 18 V.S.A. §9410 and Regulation H-2008-01, Section 3.

As specified in Regulation H-2008-01 for VHCURES, health insurers providing services to Vermont residents including TPAs and PBMs are also required to register with the State’s designated claims data collection contractor Onpoint  Health Data. After registering, health insurers including TPAs and PBMs will be notified about whether they will be required to submit claims data to the State of Vermont based on a minimum enrollment threshold for each specified line of business including major comprehensive medical benefit plans, Medicare Supplement, Medicare Parts C and D. Bulletin No. HCA-125 contains a synopsis of the regulation pertaining to the registration requirement.

Under a separate program established by the state legislature and administered by the Agency of Human Services, health insurers including TPAs and PBMs providing services to Vermont residents are required to contribute to the Vermont Health Care Information Technology Reinvestment Fund with the exception of Medicare Parts C and D that are not subject to the surcharge.