An act relating to unmerging the individual and small group health insurance markets
H.35 amends Vermont’s health insurance statutes to “unmerge” the individual and small group markets beginning January 1, 2026. The bill revises definitions and enrollment rules in 33 V.S.A. chapter 18 so that health plans offered to individuals and plans offered to small employers are treated as separate markets rather than a combined market structure. It updates the Vermont Health Benefit Exchange’s duties and the rules governing who may buy coverage through the Exchange, how carriers register, and how guaranteed issue and community rating apply in each market.
The bill also adjusts the definition of “small employer” and “qualified employer,” generally preserving the Affordable Care Act-based framework but updating statutory language to reflect separate individual and small-group plan administration. It retains provisions allowing direct enrollment through registered carriers, navigator assistance, and broker compensation arrangements, while clarifying that carriers must comply with applicable open enrollment and special enrollment rules. The act takes effect on January 1, 2026, after being signed by the Governor on February 19, 2025.
The bill changes Vermont’s insurance code by separating the individual and small group health insurance markets in the Exchange and by conforming related definitions, enrollment procedures, and carrier obligations to that separation. It affects the Vermont Health Benefit Exchange, the Commissioner of Financial Regulation, registered carriers, insurance agents and brokers, individual purchasers, and small employers purchasing coverage through the Exchange. The bill preserves core consumer protections such as guaranteed issue and community rating, but requires premiums for individual market plans and small group market plans to be determined separately.
Based on the bill text and the absence of recorded committee transcripts or votes in the provided materials, the overall sentiment appears procedural and policy-focused rather than overtly contentious. The legislation was enacted and signed into law, which suggests sufficient support for the market restructuring. The bill’s framing as an “unmerging” measure indicates a targeted insurance-market adjustment rather than a broad ideological overhaul.
The main policy issue is the separation of the individual and small group markets, which can affect premium setting, risk pools, and how insurers administer coverage. Potential points of concern include whether unmerging will change costs for individuals or small employers, how it will affect market stability, and how the Exchange and carriers will implement separate market rules. Another possible area of interest is the continued role of brokers, navigators, and direct enrollment, though no specific opposition or competing viewpoints are documented in the provided materials.