The Catamount Health Plan evolved through a less ambitious compromise between a Democratically-controlled state legislature looking to create a state-run health plan for uninsured Vermonters and a Republican governor who wanted to support and protect the current privately-run health insurance model in which most citizens obtained their health coverage through their employers. The goal Catamount Health is to insure some 20,000 residents who are legitimately uninsured to get closer to having 95% of all Vermonters covered by health insurance. Presently, state officials estimate that between 60,000 and 65,000 Vermonter residents are without health coverage either through private or government sources.
Enrollment for the Catamount Health Plan began October 1st, 2007 with a November 1st effective date. The new medical plan is intended to attract moderate income Vermonters through premium subsidies, although anyone can apply so long as they have not been covered for at least a year or have recently lost coverage due to a loss of job, divorce, death of the primary subscriber or similar life event. If the employer offers an individual a comparable health plan to the Catamount plan, that employee may be eligible for a state subsidy to make his/her share of monthly premiums more affordable. For more information you can call the consumer information line at (800) 250-8427. You can also visit the state web sites at www.hcr.vt.gov or www.greenmountaincare.org. In the near future, the state of Vermont will be grouping all of the publically sponsored medical plans under the title Green Mountain Care.

Catamount Coverages and Monthly Costs

Catamount generally offers better coverage than most plans in the private sector with premiums that are between $100 to $150 per month less than a comparable single/individual plan. Briefly, the in-network benefits (out-of-network benefits have higher deductibles and no allowance for office visit co-payments) include;

• $10 co-payments for office visits with the balance picked up by the insurance;
• $10 co-payments for naturopathic physician visits and acupuncturist services;
• Preventive care services (physicals, well-baby and child check-ups, immunizations, female well-care, screening mammograms, PSA tests and colonoscopy screenings.
• No co-payments for services related to a chronic illness such as diabetes or obesity so long as the patient is enrolled in the chronic care management program;
• No co-payment or deductible for preventive care services such as routine physicals, female well care, well baby and shild exams, mammograms and Pap tests;
• $250 calendar year deductible for single and $500 deductible for family coverage;
• 20% co-insurance (you pay 20% and the plans pays the other 80%) for covered services for the next $2,750 for single and $5,500 for two-person or family coverage;
• Total out-of-pocket (the amount one would have to pay including deductible and co-insurance for treatment of a major medical condition for covered services with in-network physicians and facilities) are $!,500 for single and $3,000 for two-person/family coverage;
• Prescription drug co-payments are $10.00 for generic, $30 for drugs on the preferred list and $50 for non-preferred medications. There is no separate Rx deductible.
• Lifetime benefit of $1,000,000.

At this time the two larger carriers are participating in Vermont's Catamount Health Plan: Blue Cross Blue Shield of Vermont and MVP Health Care. The medical networks of participating providers and facilities of both carriers are very comprehensive and comparable throughout the state, so that participants should not have to change doctors in order qualify for the richer in-network benefits. The monthly premiums of both carriers are exactly the same as well:

In addition, individuals and families whose family incomes fall below three times the Federal Poverty Level (FPL) will qualify for premium subsidies. Thus a single individual earning up to $33,000 per year and a family of four earning up to $64,000/yr. for 2007 may be eligible for a subsidy. The lowest eligible income earners they may owe as little as $60.00 per month for their health insurance, while a single coverage for an individual with income near the 300% on FPL will have a premium payment of $135.00 in 2007. There appears to be a big jump in the non-subsidized premium for subscribers earning more then 300% of the FPL.

Funding Sources to Cover the Program's Cost

The sources of funding as provided for in the Catamount legislation include federal Medicaid grants, the state's Medicaid matching funds, premium contributions from enrollees, the modest out-of-pocket charges paid by participants as they utilize the plan and a special assessment placed on employers who either do not sponsor health insurance for their employees or who have a large number of employees who refuse coverage and are not covered by another comprehensive insurance plan. Such an other health plan could be one obtained through a spouse, another job, the military or Medicare.

A recent announcement from the Bush administration has put a new wrinkle into the funding sources just as Catamount Health was being launched. Since federal grants are one source of the program's funding, the Feds have a stake in how the program is run. In late September, President Bush denied Vermont's waiver request (and that of other states) to raise the factor for determining eligibility to 300% of the FPL and instead of the current 200%. Vermont officials plan to continue to determine eligibility based on the higher factor and are searching for other funding sources.

The 2007 special assessment is $91.25 per quarter or $365 for the year for each qualified, uninsured full-time employee working for that employer. A qualified employee is one who would be listed on the employer's quarterly unemployment insurance filing with the state. The legislation provided for the fee to be adjusted for inflation each year.

Special Assessments Exemptions for Employers

Exemptions from paying the special assessment were built into the initial law and a subsequent amendment for certain uninsured workers:

• part-time employees;
• farm hands on small farms;
• full-time college students employed in work-study programs;
• elected officials;
• emergency volunteers such as fire fighters or ambulance crews;
• licensed insurance and real estate commissioned sales people (i.e. independent contractors);
• seasonal employees working less than 520 hours in a quarter unless covered by Medicaid or VHAP; and
• employees under the age of 18 (who would presumably be covered by a parent under a two-person or family plan).

In an effort to help small businesses in the early years of this new health plan, the law provides out-right exemptions of the special assessment for 8 full-time employees during 2007 and 2008, 6 qualified employees in 2009 and finally leveling off at 4 employees thereafter.

What is "Crowd-Out"?

The legislature anticipated the new Catamount Plan would be attractive enough that some unscrupulous employers might try to circumvent the law in order to shift employees onto the state plan. To prevent the phenomenon of "crowd-out", the rules allow carriers (with prior approval of the Commissioner of Banking, Insurance, Securities and Health Care Administration), to decline coverage for any individual who becomes uninsured "...primarily to obtain access to Catamount Health in a manner that is contrary to the intent of the Act." An employer dropping health coverage for other than truly financial reasons might be an example of an elicit action to cause employees to migrate to the less expensive medical plan.

Apply Today

If you think you and/or your family qualify for the Catamount Health Plan, you are urged to contact the consumer help line at (800) 250-8427 for more information. The long-term goal of insuring all Vermonters with a secure health insurance plan is worthwhile.