The national Medical Plans guide covers plan types (indemnity, HMO, PPO, POS, HDHP with HSA), cost sharing and managed-care tools. This guide covers the Vermont rules. Vermont's individual and small-group market is community rated and sold through the Vermont Health Benefit Exchange. Insurers may not pay agents commissions on those plans. Vermont also sets mandated dependent coverage, short-term plan limits, premium notice and grace rules, and external review. Most of the rules are in 8 V.S.A. chapter 107, which was renumbered effective September 1, 2025, and 33 V.S.A. § 1811.

The individual and small-group market (33 V.S.A. § 1811)

• Plans for individuals and small employers are community rated. Rates may not vary by age, gender or other demographics, geography, industry, health status, claims experience or how long someone has been covered. Rates differ only by tier: single, two-person and family.
• A small employer averaged no more than 100 employees on working days in the past calendar year.
• Carriers must guarantee acceptance of every small employer and its employees and dependents for any plan they offer in the small-group market.

Agents and the Exchange (8 V.S.A. § 4022)

• An insurer may not pay any commission, fee or other compensation to an agent or broker for selling a § 1811 individual or small-group plan, and agent costs can't be built into the rates.
• The Vermont Health Benefit Exchange itself may pay agents or brokers outside the insurance rates.
• Rebating on these plans is prohibited for the insurer, the agent and the person who accepts it.

Premium notice and grace (8 V.S.A. § 4021)

A major medical policy must:

• send notice of each premium due at least 21 days before the due date
• give a grace period of at least one month for each premium after the first. The plan stays in force during grace, and the insurer pays valid claims incurred before the grace period ends.

Required coverage for children (8 V.S.A. § 4057)

• Adult children: dependent coverage stays available until the child turns 26. This doesn't apply to specified-disease or limited-benefit coverage.
• Newborns are covered from birth for at least 60 days without notice or extra premium. If a premium is due after that, the insurer may require notice and payment within at least 60 days of birth.
• Adopted children are covered from placement on the same terms as natural children, whether or not the adoption is final, with no preexisting-condition limits.

Short-term plans (8 V.S.A. § 4053)

Short-term coverage must end three months or less after it starts, can't be renewed, and can't cover anyone for more than three months in any 12-month period.

HMOs and external review

• An HMO furnishes comprehensive health care services to enrolled members, directly or through arrangements, for periodic payments agreed in advance (8 V.S.A. § 5101(2)).
• After exhausting the plan's internal appeals, a member may get independent external review of decisions such as medical-necessity denials, when the service costs the plan at least $100 (8 V.S.A. § 4063(b)).

Enforcement

• Before finding a health insurer in violation and ordering it to stop, the Commissioner gives at least 10 days' notice and a hearing (8 V.S.A. § 4014(b)(2)).
• An intentional violation of chapter 107 can bring a penalty of up to $750 and suspension or revocation of the insurer's or agent's license (§ 4015).

Guaranty protection

The Vermont Life and Health Insurance Guaranty Association covers health benefit plans up to $500,000. Other health coverage that isn't disability income or LTC is covered up to $100,000 (8 V.S.A. § 4173(c)).

Common exam traps

• Vermont's individual and small-group rates are community rated, with no age rating. They vary only by single, two-person or family tier.
• A small employer has up to 100 employees.
• Insurers may not pay agents commissions on these plans. Only the Exchange may pay agents.
• The premium notice is 21 days before the due date, and grace is at least one month.
• Newborns are covered automatically for 60 days. Adult children may stay on until 26.
• Short-term plans are limited to 3 months and can't be renewed.
• External review applies when the service costs at least $100.