Green Mountain Care Board issues decision on BlueCross BlueShield Vermont large group formula

MONTPELIER — State health care regulators have trimmed a rate increase request from a large health insurance provider, but the average person won't be able to tell given how many other factors go into what they end up paying.

The Green Mountain Care Board announced Thursday that it reached a decision on BlueCross and BlueShield of Vermont's filing for large group insurance.

Large groups are employer groups with 100 more people, according to the care board's release.

According to the care board, the insurance company had requested a 17.3% rate increase, but this was denied. After working with BCBSVT, the care board approved a 13.7% increase.

Green Mountain Care Board Chair Owen Foster said Friday that the 13.7% is only the basis of a formula that still has to factor in a large group's history, hospital rates, and what BCBSVT is able to negotiate.

"It's not the premium increase that all large groups will experience," said Foster. "Each large group has an experience rating; what happened to those people last year, what were their claims, how sick were they, so it can adjust. And then we also have hospital budget decisions, and Blue Cross will negotiate, and all of those things. So this isn't like a for-sure number."

He said there are 33 large groups in Vermont that this decision applies to, encompassing about 5,000 people.

According to a Green Mountain Care Board release, BCBSVT was told to reduce its manual rate by 0.2% to be more in line with hospital budget guidance the board gave for the 2026 fiscal year. It was also told to reduce the manual rate by another 0.7% to reflect some budget enforcement action taken by the care board over the 2023 fiscal year budgets for University of Vermont Medical Center, and Rutland Regional Medical Center.

On June 13, Rutland Superior Court Judge Alexander Burke issued a decision on Rutland Regional Medical Center's appeal of the Green Mountain Care Board's decision over the hospital's 2023 fiscal year budget, reversing it and remanding it for further proceedings.

BCBSVT was also told to reduce the manual rate by 2.8% because of Act 55, a law signed by Gov. Phil Scott on June 11 aimed at lowering the cost of prescription drugs issued through hospitals.

"Vermont had the largest, by a large margin, outpatient drug prices, hospital administered drug prices, and the Legislature and the governor capped it, and that really reduced the health care expenses," said Foster.

That law won't take effect until Jan. 1, 2026, but neither will the rate the care board just approved, so the timing works out, said Foster.

He said that BCBSVT has the right to appeal this decision, but hasn't spoken to anyone from the company about it yet.

BlueCross BlueShield of Vermont did not respond to an email seeking comment.

Foster said the rates for small groups and individuals will be set later this year.

He said that the state has formed a Health Care Reform Workgroup which is expected to produce a report by the end of June on ways to reduce health care costs. Foster said that the rates of health insurance companies and hospitals are deeply intertwined and cutting or raising one can impact the other.

keith.whitcomb

@rutlandherald.com