Health Insurers Annual Reports
Legislatively mandated Health Insurers Annual Reports include statistics regarding claims, appeals, marketing and advertising expenses, lobbying and legal fees, and political contributions along with other financial data.
Annual Reports | Act 152
Quality Assurance Report
The provisions of Title 18 V.S.A. § 9414(a)(5) requires that the Commissioner, commencing with calendar year 2016, prepare an annual report on or before July 1 of each year providing the number of complaints received during the previous calendar year regarding violations or suspected violations of the standards set forth in this section or adopted by rule pursuant to this section. The report is to specify the aggregate number of complaints related to each standard, and such reports may be found here.
Quality Assurance Complaints for Managed Care - 2018
Network Adequacy Reporting
H-2009-03, Consumer Protection and Quality Requirements for Managed Care Organizations, helps to ensure consumer protection and quality requirements that managed care organizations (MCO). MCOs are required to submit their reports to the department on or before July 15 annually. Below are the most recent reports from plan year 2021.
Filing and Reporting Instructions
Please send Baseline Review Filings and Network Adequacy Reporting via USPS to:
Department of Financial Regulation
Attn: Sebastian Arduengo
89 Main Street
Montpelier, VT 05620
To receive confirmation of receipt of your mail by the Department, you must provide the following:
- A copy of the submission
- A self-addressed envelope
Prior Authorization Reporting
The Department of Financial Regulation and the Green Mountain Care Board require issuers attesting compliance under 18 V.S.A. § 9418b(h) to submit:
- A general description of the standards used by insurers to evaluate Prior Authorization (PA) requirements.
- A list of services for which PA requirements were eliminated or added during the preceding plan year and the rationale for changing those requirements.
- A list of the ten most requested PA and the PA approval rate for those PA; and
- The percentage of urgent and non-urgent PA requests granted because processing time exceeded the statutory timeframes established under 18 V.S.A. § 9418b(g)(4).