Haw. Rev. Stat. § 431P-5 — HI Code / Division 2 / Title 24 / Chapter 431P / Section 431P-5
Powers, duties, and functions.
Status: in_force

(a) The Hawaii hurricane relief fund shall have the following general powers:

(1) To sue and be sued;

(2) To make and alter policies for its organization and internal administration;

(3) To adopt rules in accordance with chapter 91 to effectuate the purposes of this chapter;

(4) To borrow moneys, including but not limited to moneys from federal or state sources and to issue notes or other obligations of the fund for the purposes of providing funds for any of its purposes as authorized by the legislature from time to time;

(5) To pledge, assign, or grant a security interest in all or any part of the moneys, rents, charges, assessments, or other revenue and any proceeds thereof derived by the fund; provided that any pledge, assignment, or grant of security interest shall constitute a lien and security interest on the money, rents, charges, assessments, or other revenue, and any proceeds thereof to the extent and with the priority set forth in the document establishing the pledge, assignment, or security interest, without the necessity for physical delivery, recording, or further act; and provided further that in effectuating any pledge, assignment, or grant of security interest, the fund may do either or both of the following:

(A) Transfer possession of collateral to its secured parties; or

(B) Execute and cause to be filed at the bureau of conveyances of the State of Hawaii, Uniform Commercial Code financing statements for the purpose of providing notice to third parties of a pledge, assignment, or grant of security interest; provided that any failure to file a financing statement or the filing of a financing statement that contains incomplete or inaccurate information shall not affect the perfected lien and security interest of the pledge, assignment, or grant of security interest; and

(6) Enter into contracts as necessary to effectuate the purposes of this chapter.

(b) In addition to the general powers under subsection (a), the fund shall have the specific power to:

(1) Adopt and administer a plan of operation in accordance with section 431P-7, and a manual of rules and rates to provide persons having an insurable interest in eligible property with insurance coverage provided by the fund;

(2) Authorize the provision of hurricane coverage by the fund for real property and tangible personal property located in or on real property and establish limits of liability for specific coverages within the range of authorized coverage;

(3) Adopt actuarially sound rates based on reasonable assumptions relative to expectations of hurricane frequency and severity for all coverage provided under policies or endorsements issued by the fund. Rates adopted shall be subject to approval by the commissioner pursuant to article 14 of chapter 431. Rates adopted shall provide for classification of risks and shall include past and prospective losses and expense experience in this State;

(4) Adopt procedures, guidelines, and surcharges applicable to policies of hurricane property insurance issued in connection with an underlying property policy issued by an unauthorized insurer;

(5) Adopt any form of insurance policy necessary for providing policies of hurricane property insurance by the fund, with the approval of the commissioner;

(6) Issue policies of hurricane property insurance and pay claims for coverage over the mandatory deductible or other deductible provided in the plan of operation or any manual of rules and rates adopted under the plan of operation;

(7) Contract with one or more licensed property and casualty insurers transacting direct property insurance business in this State or an entity specializing in providing insurance administration to act as a servicing facility, and by contract with that servicing facility authorize the servicing facility to inspect eligible properties, service policies and policyholders of hurricane property insurance, provide claim services, and perform any other duties as authorized by the fund for applicants to the fund and those insured by it;

(8) (A) Assess all licensed property and casualty insurers the amounts that, together with the other assets of the fund, are sufficient to meet all necessary obligations of the fund. The assessment shall be made on the insurer's gross direct written premiums for property and casualty insurance in this State for the preceding calendar year. The rate of assessment shall be established by the board and in a year in which a covered event has not occurred may be up to a percentage not to exceed 3.75 per cent and shall not include the insurer's gross direct written premiums for motor vehicle insurance in this State; provided that following a covered event, the rate of assessment may be increased to an amount not to exceed five per cent and may include the insurer's gross direct written premiums for motor vehicle insurance in this State. This increase shall remain in effect until the time all claims and other obligations, including but not limited to bonds and notes, arising out of a covered event have been fully discharged. The assessment for a year in which a covered event has not occurred shall be collected quarterly during each calendar year;

(B) If a loss occurs from a covered event, in addition to the assessment in subparagraph (A), assess those insurers that acted as servicing facilities during the twelve months ending at the start of the month preceding the month in which the covered event occurs. The total assessment shall be a fixed percentage of the total coverage provided by the fund under its policies of hurricane property insurance during the month preceding the month in which the covered event occurs. The percentage to be used in calculating the total assessment shall be:

(i) For calendar year 2001 through calendar year 2025, 1.5 per cent; and

(ii) Beginning January 1, 2026, a percentage not to exceed 1.5 per cent as determined by the board.

A separate total assessment shall be made for each covered event. The total assessment shall be allocated to each servicing facility based on the proportion of the total amount of the fund's gross direct written premiums for policies of hurricane property insurance serviced by each servicing facility to the total amount of the fund's gross direct written premiums for policies of hurricane property insurance, in each case, during the twelve months ending at the start of the month preceding the month in which the covered event occurs. Assessments made under this subparagraph and those under subparagraph (A) in a year in which a covered event has occurred are due from each insurer based on assessment procedures established by the fund to meet its obligations to policyholders in a timely manner; and

(C) Exempt or defer, in whole or in part, the assessment of any insurer if the assessment would cause the insurer's financial statement to reflect amounts of capital or surplus less than the minimum amounts required for a certificate of authority in this State;

(9) Develop a program of incentives to encourage insurers to provide policies of hurricane property insurance that may include but are not limited to exemption of the insurer's gross direct written premium for property insurance from the assessment pursuant to paragraph (8)(A);

(10) Develop procedures regarding policies written by unauthorized insurers comparable to the assessments, surcharges, and other contributions made by insurers authorized to do business in this State;

(11) Accumulate reserves or funds, including the investment income thereon, to be used for paying expenses, making or repaying loans or other obligations of the fund, providing loss mitigation incentives, and paying valid claims for covered events insured by the fund;

(12) Collect and maintain statistical and other data as may be required by the commissioner;

(13) Impose fines for each incident of nonpayment of amounts due to the fund under this chapter; provided that the fines shall not exceed twenty-five per cent of the amount then due;

(14) Create loss mitigation incentives, including but not limited to premium credits, premium rebates, loans, or cash payments;

(15) Enter into claims financing transactions, including but not limited to reinsurance transactions, debt transactions, and other transactions incorporating elements of reinsurance, insurance, debt, or equity;

(16) Establish business and corporate entities or organizations pursuant to the purposes of this chapter;

(17) Receive for deposit into separate accounts within the hurricane reserve trust fund established pursuant to section 431P-16 revenues received from any fee revenue authorized by the legislature for deposit into the hurricane relief trust fund, and any other source of revenue available to the board;

(18) Notwithstanding any law to the contrary, loan funds to the Hawaii Property Insurance Association established under section 431:21-103; and

(19) Perform any and all acts reasonably necessary to carry out the purposes of this chapter. [L 1993, c 339, pt of §2; am L Sp 1995, c 17, §2; am L 1996, c 307, §7; am L 1998, c 106, §4 and c 304, §2; am L 2001, c 153, §1; am L 2025, c 296, §11]
Haw. Rev. Stat. § 432E-7 — HI Code / Division 2 / Title 24 / Chapter 432E / Section 432E-7
Information to enrollees.
Status: in_force

(a) The managed care plan shall provide to its enrollees upon enrollment and thereafter upon request the following information:

(1) A list of participating providers which shall be updated on a regular basis indicating, at a minimum, their specialty and whether the provider is accepting new patients;

(2) A complete description of benefits, services, and copayments;

(3) A statement on enrollee's rights, responsibilities, and obligations;

(4) An explanation of the referral process, if any;

(5) Where services or benefits may be obtained;

(6) Information on complaints and appeals procedures; and

(7) The telephone number of the insurance division.

This information shall be provided to prospective enrollees upon request.

(b) Every managed care plan shall provide to the commissioner and its enrollees notice of any material change in participating provider agreements, services, or benefits, if the change affects the organization or operation of the managed care plan and the enrollee's services or benefits. The managed care plan shall provide notice to enrollees not more than sixty days after the change in a format that makes the notice clear and conspicuous so that it is readily noticeable by the enrollee.

(c) A managed care plan shall provide generic participating provider contracts to enrollees, upon request. [L 1998, c 178, pt of §2; am L 1999, c 137, §7]
Haw. Rev. Stat. § 431N-6 — HI Code / Division 2 / Title 24 / Chapter 431N / Section 431N-6
Reporting, continued funding.
Status: in_force

The department of health shall report to the legislature on or about October 1, 1989, on the progress made in implementation of this chapter, including:

(1) Establishment of an advisory committee to review: the scope of the work to be done by a consultant, the input from the committee and the community to the consultant, and the schedule of work of the advisory committee;

(2) Final scope of work for the consultant, selection of the consultant, and the consultant's workplan;

(3) Involvement of the departments of labor and industrial relations, human services, and other departments needed to successfully develop the program;

(4) Required data collection efforts to successfully develop the program.

The department of health, in collaboration with the health care contractors, shall submit reports to the legislature and the governor no later than twenty days prior to the convening of each and every legislative session regarding program activities and expenditures, needed resources, participant demographics, evaluations, and such other information as may be necessary to determine the usefulness of and continued need for the state health insurance program.

The purchase of insurance shall not proceed without the formal approval of the governor and a review by the legislature during the 1990 regular session. Implementation is predicated upon the successful completion of the consultant's reports and findings. The legislature, by concurrent resolution, may opt to withhold funding appropriated for implementation if not satisfied with the plan, provided that such a concurrent resolution must be passed within thirty days after completion of the implementation plan or March 1, 1990, whichever occurs last. [L 1989, c 378, pt of §1; am L 1993, c 6, §21]
Haw. Rev. Stat. § 431P-16 — HI Code / Division 2 / Title 24 / Chapter 431P / Section 431P-16
Establishment of trust funds.
Status: in_force

(a) The fund shall establish outside the state treasury a hurricane reserve trust fund and any accounts thereunder and any other trust fund or account necessary to carry out the purposes of this chapter. Moneys deposited in the hurricane reserve trust fund and any accounts thereunder or any other trust fund or account shall be held by the fund, as trustee, in a depository as defined in section 38-1 or according to a similar arrangement at the discretion of the board, including, but not limited to, trust or custodial accounts created for the benefit of the fund's secured parties under contractual claims financing arrangements. These moneys may be invested and reinvested in accordance with the plan of operation. Disbursements from the trust funds shall not be subject to chapter 103D and shall be made in accordance with procedures adopted by the board.

(b) The Hawaii hurricane relief fund may implement the assessments of all property and casualty insurers authorized by section 431P-5(b)(8)(A) and (B) and the proceeds from the assessments shall be deposited into the hurricane reserve trust fund or into trust or custodial accounts, created for the benefit of the fund's secured parties, that are held inside or outside the hurricane reserve trust fund; provided that after December 31, 2025, all proceeds realized from the collection of the assessments shall be deposited into a separate trust account within the hurricane reserve trust fund.

(c) If the Hawaii hurricane relief fund offers to issue policies of hurricane property insurance, the premiums for the policies shall be deposited into the hurricane reserve trust fund.

(d) After each covered event, if the board determines that the moneys in the hurricane reserve trust fund, excluding moneys determined by the board to be needed to continue fund operations following the covered event, will be insufficient to pay claims and other obligations of the fund arising out of that covered event, the Hawaii hurricane relief fund shall levy a surcharge not to exceed seven and one-half per cent a year on premiums charged for all property and casualty insurance policies issued for risks insured in this State. These moneys may be deposited into the hurricane reserve trust fund or into trust or custodial accounts created for the benefit of the fund's secured parties that are held inside or outside the hurricane reserve trust fund. The surcharge shall remain in effect until all claims and other obligations of the fund, including but not limited to claims under fund policies of hurricane property insurance, claims financing transactions, bonds, notes, and other obligations arising out of that covered event have been fully discharged. The amount and reason for any surcharge made pursuant to this subsection shall be separately stated on any billing sent to an insured. The surcharge shall not be considered premiums for any other purpose including the computation of gross premium tax or the determination of producers' commissions. The fund may establish procedures for insurers to collect the surcharge from customers who hold property or casualty policies.

(e) Any proceeds, experience refunds, or other return funds under reinsurance shall be deposited into the hurricane reserve trust fund.

(f) Any proceeds from loans or other moneys from the federal government, any proceeds from bonds issued pursuant to this chapter loaned by the director to the Hawaii hurricane relief fund, any revenues derived from the temporary recording fee pursuant to section 431P-20, and other moneys as the State may make available from time to time shall be deposited into separate accounts of the hurricane reserve trust fund.

(g) Moneys in the hurricane reserve trust fund or in trust or custodial accounts, created for the benefit of the fund's secured parties, shall be expended by the Hawaii hurricane relief fund or its authorized designee and used solely for the purposes of this chapter.

(h) Moneys in the hurricane reserve trust fund may be disbursed upon dissolution of the Hawaii hurricane relief fund; provided that:

(1) The net moneys in the hurricane reserve trust fund shall revert to the state general fund after payments by the fund on behalf of licensed property and casualty insurers or the State that are required to be made pursuant to any federal disaster insurance program enacted to provide insurance or reinsurance for hurricane risks are completed; and

(2) If the moneys are paid on behalf of licensed property and casualty insurers, payment shall be made in proportion to the premiums from policies of hurricane property insurance serviced by the insurers in the twelve months prior to dissolution of the fund. [L 1993, c 339, pt of §2; am L Sp 1995, c 17, §6; am L 1996, c 307, §8; am L 1998, c 106, §7; am L 1999, c 151, §1; am L 2001, c 153, §2; am L 2002, c 155, §102 and c 179, §5; am L 2011, c 81, §10 and c 124, §47; am L 2025, c 296, §16]
Haw. Rev. Stat. § 431C-5 — HI Code / Division 2 / Title 24 / Chapter 431C / Section 431C-5
Contract requirements.
Status: in_force

(a) No person may use any form of life settlement contract in this State unless it has been filed with and approved, if required, by the commissioner in a manner that conforms with the filing procedures and any time restrictions or deeming provisions, if any, for life insurance forms, policies, and contracts.

(b) No insurer may, as a condition of responding to a request for verification of coverage or in connection with the transfer of a policy pursuant to a life settlement contract, require that the owner, insured, provider, or broker sign any form, disclosure, consent, waiver, or acknowledgment that has not been expressly approved by the commissioner for use in connection with life settlement contracts in this State.

(c) A person shall not use a life settlement contract form or provide to an owner a disclosure statement form in this State unless first filed with and approved by the commissioner. The commissioner shall disapprove a life settlement contract form or disclosure statement form if, in the commissioner's opinion, the contract or provisions contained therein fail to meet the requirements of sections 431C-21, 431C-31, 431C-33, and 431C-43 or are unreasonable, contrary to the interests of the public, or otherwise misleading or unfair to the owner. At the commissioner's discretion, the commissioner may require the submission of advertising material. [L 2012, c 256, pt of §1]
Haw. Rev. Stat. § 431K-10 — HI Code / Division 2 / Title 24 / Chapter 431K / Section 431K-10
Penalties.
Status: in_force

A risk retention group which violates any provision of this chapter shall be subject to fines and penalties applicable to licensed insurers generally, including revocation of its license, the right to do business in this State, or both. All penalties collected pursuant to this section and section 431K-3.5 shall be deposited to the credit of the compliance resolution fund.
Haw. Rev. Stat. § 432E-33 — HI Code / Division 2 / Title 24 / Chapter 432E / Section 432E-33
[ §432E-33] Request for external review.
Status: in_force

[ §432E-33] Request for external review. (a) All requests for external review of a health carrier's adverse action shall be made in writing to the commissioner and shall include:

(1) A copy of the final internal determination of the health carrier, unless exempted pursuant to subsection (b);

(2) A signed authorization by or on behalf of the enrollee for release of the enrollee's medical records relevant to the external review;

(3) A disclosure for conflict of interests evaluation, as provided in section 432E-43; and

(4) A filing fee of $15, which shall be deposited into the compliance resolution fund established pursuant to section 26-9(o); provided that the filing fee shall be refunded if the adverse determination or final internal adverse determination is reversed through external review.

The commissioner shall waive the filing fee required by this subsection if the commissioner determines that payment of the fee would impose an undue financial hardship to the enrollee. The annual aggregate limit on filing fees for any enrollee within a single plan year shall not exceed $60.

(b) The internal appeals process of a health carrier shall be completed before an external review request shall be submitted to the commissioner except in the following circumstances:

(1) The health carrier has waived the requirement of exhaustion of the internal appeals process;

(2) The enrollee has applied for an expedited external review at the same time that the enrollee applied for an expedited internal appeal; provided that the enrollee is eligible for an expedited external review; or

(3) The health carrier has substantially failed to comply with its internal appeals process. [L 2011, c 230, pt of §2]
Haw. Rev. Stat. § 431N-1 — HI Code / Division 2 / Title 24 / Chapter 431N / Section 431N-1
Findings and purpose.
Status: in_force

(a) The legislature finds that despite the fact that Hawaii has the only statutorily mandated prepaid health care program in the country, as well as a broad-based medicaid program which provides an array of medical benefits to Hawaii's lowest income level residents, there remain in the State uninsured "gap group individuals". Available statistics consistently reveal that an estimated five per cent of the civilian population of this State, or 50,000 individuals, lack any form of medical insurance whatsoever and are therefore limited in access to medical care.

(b) These "gap group individuals" are characterized by one or more of the following conditions or factors contributing to lack of insurance or "medical indigency":

(1) They have too much income or too many assets to qualify for medicaid, but too little to afford private insurance;

(2) They do not qualify for prepaid health care insurance coverage through employment;

(3) They choose not to obtain health insurance; or

(4) They are dependents, primarily children of insureds who are not covered by their parent's, guardian's, or spouse's policies.

(c) The legislature further finds that it is a matter of compelling public interest to provide for the health and well-being of all the people of this State. This is also consistent with the health provisions of the Hawaii State Planning Act as set forth in section 226-20(a)(1), which establish as an objective the "fulfillment of basic individual health needs of the general public." This objective is construed to include access to basic health insurance coverage. To responsibly carry out this objective, it is therefore appropriate that the legislature use innovative means to ensure that all residents, regardless of age, income, employment status, or any other factor, have access to health insurance coverage which will provide basic medical services necessary to sustain a healthy life.

(d) The purpose of this chapter is to establish a program within the department of health, funded through legislative appropriations, to ensure basic health insurance coverage is available for Hawaii residents who are medically uninsured and who are defined in section 431N-2 as "gap group individuals". [L 1989, c 378, pt of §1]
Haw. Rev. Stat. § 432D-22 — HI Code / Division 2 / Title 24 / Chapter 432D / Section 432D-22
Acquisition of control of or merger of a health maintenance organization.
Status: in_force

No person may make a tender for or a request or invitation for tenders of, enter into an agreement to exchange securities for, or acquire in the open market or otherwise, any voting security of a health maintenance organization or enter into any other agreement if, after the consummation thereof, that person, directly or indirectly, or by conversion or by exercise of any right to acquire, would be in control of the health maintenance organization, and no person may enter into an agreement to merge or consolidate with or otherwise to acquire control of a health maintenance organization, unless, at the time any offer, request, or invitation is made or any agreement is entered into, or prior to the acquisition of the securities if no offer or agreement is involved, the person has filed with the commissioner and has sent to the health maintenance organization information required by section 431:11-104 and the offer, request, invitation, agreement, or acquisition has been approved by the commissioner. Approval by the commissioner shall be governed by section 431:11-104(d); provided that if no action is taken by the commissioner within thirty days, the offer, request, invitation, agreement, or acquisition shall be deemed approved.
Haw. Rev. Stat. § 431P-5.5 — HI Code / Division 2 / Title 24 / Chapter 431P / Section 431P-5.5
Accumulation of $500,000,000 in funds and commitments.
Status: in_force

(a) Upon written confirmation from the commissioner that the director has secured $500,000,000, in the aggregate, in the form of:

(1) Commitments from either the federal government or an agency of the federal government or a financial institution;

(2) Revenue bonds other than those issued or to be issued in response to the occurrence of a covered event; or

(3) A combination of the commitments or bonds,

the Hawaii hurricane relief fund shall control or freeze rates and continue accumulating premiums from policies of hurricane property insurance, net of any reinsurance payments, operating expenses, and funds necessary for the development of a comprehensive loss reduction plan.

(b) When the balance of the net moneys accumulated totals $500,000,000, the Hawaii hurricane relief fund may notify the insurance commissioner of that fact. The insurance commissioner, in turn, may order, following the receipt of the notice, a reduction in the rates for policies of hurricane property insurance.

(c) If a loss from a covered event occurs, the net moneys accumulated shall be used to settle claims and pay current and ongoing expenses of the Hawaii hurricane relief fund. The net accumulated moneys, commitments, and bonds described in subsection (a) shall be used only if losses from a covered event exceed the assessment pursuant to section 431P-5(b)(8)(B).

(d) If the balance of the net accumulated moneys falls below $400,000,000, the Hawaii hurricane relief fund shall establish rates, subject to the approval of the commissioner, necessary to replenish the account balance to $500,000,000, as promptly as reasonably practicable. The director shall seek to arrange additional commitments whenever the account balance falls below $400,000,000.

(e) The Hawaii hurricane relief fund shall be exempt from paying all taxes and fees levied by the State on other insurers. [L Sp 1995, c 32, §2; am L 2000, c 76, §1; am L 2025, c 296, §12]
Haw. Rev. Stat. § 435C-7 — HI Code / Division 2 / Title 24 / Chapter 435C / Section 435C-7
Appeals and judicial review.
Status: in_force

Any applicant to the plan, any person insured pursuant to this chapter, or their representatives, or any affected insurer, may appeal to the insurance commissioner within thirty days after any ruling, action or decision by or on behalf of the plan, with respect to those items the plan of operation defines as appealable matters.

All orders of the insurance commissioner made pursuant to this chapter shall be subject to judicial review as provided in section 431:14-118. [L 1975, c 161, pt of §1]

Revision Note

Section "431:14-118" substituted for "431-705".
Haw. Rev. Stat. § 431L-6 — HI Code / Division 2 / Title 24 / Chapter 431L / Section 431L-6
Requirements for coverage of an adopted child.
Status: in_force

(a) In any case in which a group health plan provides coverage for dependent children of participants or beneficiaries, the plan shall provide benefits to dependent children placed with participants or beneficiaries for adoption under the same terms and conditions as apply to the natural, dependent children of the participants and beneficiaries, irrespective of whether the adoption has become final.

(b) A group health plan may not restrict coverage under the plan of any dependent child adopted by a participant or beneficiary, or placed with a participant or beneficiary for adoption, solely on the basis of a preexisting condition of the child at the time that the child would otherwise become eligible for coverage under the plan, if the adoption or placement for adoption occurs while the participant or beneficiary is eligible for coverage under the plan.

(c) As used in this section:

"Child" means, in connection with any adoption, or placement for adoption, of the child, an individual who has not attained the age of eighteen as of the date of such adoption or placement for adoption.

"Placement for adoption" means the assumption and retention by a person of a legal obligation for total or partial support of a child in anticipation of the adoption of the child. The child's placement with a person terminates upon the termination of such legal obligation. [L 1995, c 83, pt of §2]
Haw. Rev. Stat. § 432G-18 — HI Code / Division 2 / Title 24 / Chapter 432G / Section 432G-18
Federally funded programs; exemption.
Status: in_force

Requirements provided in this chapter relating to mandated coverages or essential health benefits shall not be applicable to any dental insurer offering dental insurance under a federally funded program under the Social Security Act, as amended; provided that this exemption shall apply only to that part of the dental insurer's business under the federally funded program.
Haw. Rev. Stat. § 435E-19 — HI Code / Division 2 / Title 24 / Chapter 435E / Section 435E-19
Annual reports; disclosure.
Status: in_force

The board of trustees shall furnish the following to each member participating in such interindemnity arrangement, and shall file a copy with the commissioner:

(1) Within one hundred twenty days after the end of each fiscal year a statement of the assets and liabilities of the interindemnity arrangement as of the end of such year, a statement of the revenue and expenditures of the interindemnity arrangement, and a statement of the changes in corpus of the reserve trust for such year, in each case accompanied by a certificate signed by a firm of independent certified public accountants selected by the board of trustees indicating that such firm has conducted an audit of such statements in accordance with generally accepted auditing standards and indicating the results of such audit.

(2) Within forty-five days after the end of each of the first three quarterly periods of each fiscal year a statement of the assets and liabilities of the interindemnity arrangement as of the end of such quarterly period, a statement of the revenue and expenditures of the interindemnity arrangement and a statement of the changes in corpus of the reserve trust for such period, in each case accompanied by a certificate signed by a majority of the members of the board of trustees to the effect that such statements were prepared from the official books and records of the interindemnity arrangement.

In addition to the statements required to be filed pursuant to this section, the board of trustees shall annually file with the commissioner an authorization for disclosure of all financial records pertaining to the interindemnity arrangement. For the purpose of this paragraph, the authorization for disclosure shall also include the financial records of any association, partnership, or corporation that has management or control of the funds or the operation of the interindemnity arrangement. [L 1977, c 182, pt of §1; am L 1982, c 203, §16]
Haw. Rev. Stat. § 435C-1 — HI Code / Division 2 / Title 24 / Chapter 435C / Section 435C-1
Purpose.
Status: in_force

The purpose of this chapter is to provide a contingency plan to be instituted by the insurance commissioner upon the unavailability of medical malpractice insurance in this State.
Haw. Rev. Stat. § 435E-28 — HI Code / Division 2 / Title 24 / Chapter 435E / Section 435E-28
Meeting of members.
Status: in_force

There shall be a meeting of all members participating in the interindemnity arrangement, at least annually, after not less than ten days' written notice has been given, at a location reasonably convenient to the participating members and on a date which is within a reasonable period of time following the distribution of the annual financial statements.
Haw. Rev. Stat. § 432E-11 — HI Code / Division 2 / Title 24 / Chapter 432E / Section 432E-11
Accreditation of managed care plans.
Status: in_force

(a) Beginning January 1, 1999, the commissioner shall contract with one or more certified vendors of the consumer assessment health plan survey to conduct a survey of all managed care plans actively offering managed care plans in this State to provide managed care plans an opportunity to learn whether any deficiencies exist or any improvements are required; provided that the information collected shall be kept confidential in the first year, and thereafter shall be available to the public.

(b) The commissioner shall conduct a program that promotes public awareness and education about managed care plans so that consumers may make better or more informed choices when selecting a managed care plan.

(c) Beginning January 1, 2000, unaccredited plans shall submit a plan to the commissioner to achieve national accreditation status within five years. After the first year of the five-year plan, each unaccredited plan shall also submit an annual progress report to the commissioner on the status of gaining national accreditation. The commissioner shall determine which national accreditation organization is appropriate for each type of plan.

(d) Every mutual benefit society, every health maintenance organization, and every other entity offering or providing health benefits or services under the regulation of the commissioner, except an insurer licensed to offer accident and health or sickness insurance under article 10A of chapter 431, shall deposit with the commissioner a fee to provide for the actual costs of the survey and educational program to be determined by the commissioner on July 1 of each year, to be credited to the compliance resolution fund. [L 1999, c 137, pt of §2; am L 2002, c 39, §18; am L 2003, c 212, §128]
Haw. Rev. Stat. § 432D-14 — HI Code / Division 2 / Title 24 / Chapter 432D / Section 432D-14
Suspension, revocation, or denial of certificate of authority.
Status: in_force

(a) Any certificate of authority issued under this chapter may be suspended or revoked, and any application for a certificate of authority may be denied, if the commissioner finds that any of the conditions listed below exist:

(1) The health maintenance organization is operating significantly in contravention of its basic organizational document or in a manner contrary to that described in any other information submitted under section 432D-2, unless amendments to such submissions have been filed with and approved by the commissioner;

(2) The health maintenance organization does not provide or arrange for basic health care services;

(3) The health maintenance organization is no longer financially responsible and may reasonably be expected to be unable to meet its obligations to enrollees or prospective enrollees;

(4) The health maintenance organization has failed to correct, within the time prescribed by subsection (c), any deficiency occurring due to the health maintenance organization's prescribed minimum net worth being impaired;

(5) The health maintenance organization, or any person on its behalf, has advertised or merchandised its services in an untrue, misrepresentative, misleading, deceptive, or unfair manner;

(6) The continued operation of the health maintenance organization would be hazardous to its enrollees; or

(7) The health maintenance organization has otherwise failed substantially to comply with this chapter.

(b) In addition to, or in lieu of, suspension or revocation of a certificate of authority pursuant to this section, the commissioner may levy an administrative fine upon the health maintenance organization in an amount not less than $500 and not more than $50,000 pursuant to section 431:3-221.

(c) The following shall pertain when insufficient net worth is maintained:

(1) Whenever the commissioner finds that the net worth maintained by any health maintenance organization subject to this chapter is less than the minimum net worth required, the commissioner shall give written notice to the health maintenance organization of the amount of the deficiency and require the health maintenance organization to:

(A) File with the commissioner a plan for correction of the deficiency acceptable to the commissioner; and

(B) Correct the deficiency within a reasonable time, not to exceed sixty days, unless an extension of time, not to exceed sixty additional days, is granted by the commissioner. Such a deficiency shall be deemed an impairment, and failure to correct the impairment in the prescribed time shall be grounds for suspension or revocation of the certificate of authority or for placing the health maintenance organization in conservation, rehabilitation, or liquidation; and

(2) Unless allowed by the commissioner, no health maintenance organization or person acting on its behalf, directly or indirectly, may renew, issue, or deliver any certificate, agreement, or contract of coverage in this State, for which a premium is charged or collected, when the health maintenance organization writing such coverage is impaired, and the fact of such impairment is known to the health maintenance organization or to such person. However, the existence of an impairment shall not prevent the issuance or renewal of a certificate, agreement, or contract when the enrollee exercises an option granted under the plan to obtain a new, renewed, or converted coverage.

(d) A certificate of authority shall be suspended or revoked or an application for a certificate of authority denied, or an administrative penalty imposed, only after compliance with the requirements of this section.

(1) Suspension or revocation of a certificate of authority, denial of an application, or imposition of an administrative penalty pursuant to this section shall be by written order and shall be sent to the health maintenance organization or applicant by certified or registered mail. The written order shall state the grounds, charges, or conduct on which suspension, revocation, denial, or administrative penalty is based. The health maintenance organization or applicant, in writing, may request a hearing pursuant to section 431:2-308; and

(2) If the health maintenance organization or applicant requests a hearing pursuant to this section, the commissioner shall issue a written notice of hearing and send it to the health maintenance organization or applicant by certified or registered mail and to the director of labor and industrial relations stating:

(A) A specific time for the hearing, which may not be less than twenty nor more than thirty days after mailing of the notice of hearing; and

(B) A specific place for the hearing.

(e) When the certificate of authority of a health maintenance organization is suspended, the health maintenance organization shall not, during the period of such suspension, enroll any additional enrollees except newborn children or other newly acquired dependents of existing enrollees, and shall not engage in any advertising or solicitation whatsoever.

(f) When the certificate of authority of a health maintenance organization is revoked, such organization, immediately following the effective date of the order of revocation, shall proceed to wind up its affairs, and shall conduct no further business except as may be essential to the orderly conclusion of the affairs of such organization. It shall engage in no further advertising or solicitation whatsoever. The commissioner, by written order, may permit such further operation of the organization as the commissioner may find to be in the best interest of enrollees, to the end that enrollees will be afforded the greatest practical opportunity to obtain continuing health care coverage. [L 1995, c 179, pt of §1; am L 2016, c 141, §19]
Haw. Rev. Stat. § 432G-16 — HI Code / Division 2 / Title 24 / Chapter 432G / Section 432G-16
Statutory construction and relationship to other laws.
Status: in_force

(a) Except as provided in subsection (c) and otherwise provided in this chapter, the insurance laws shall not apply to the activities authorized and regulated under this chapter of any dental insurer granted a certificate of authority under this chapter.

(b) Solicitation of enrollees by a dental insurer granted a certificate of authority, or its representatives, shall not be construed to violate any provision of law relating to solicitation or advertising by providers.

(c) Articles 2, 2D, 13, and 15 of chapter 431, and the powers granted by those provisions to the commissioner shall apply to dental insurers, so long as the application in any particular case is in compliance with and is not preempted by applicable federal statutes and regulations. [L 2013, c 191, pt of §1]
Haw. Rev. Stat. § 431R-7 — HI Code / Division 2 / Title 24 / Chapter 431R / Section 431R-7
Rules.
Status: in_force

The insurance commissioner may adopt rules pursuant to chapter 91 to implement the requirements of this chapter.
Haw. Rev. Stat. § 432E-1.4 — HI Code / Division 2 / Title 24 / Chapter 432E / Section 432E-1.4
Medical necessity.
Status: in_force

(a) For contractual purposes, a health intervention shall be covered if it is an otherwise covered category of service, not specifically excluded, recommended by the treating licensed health care provider, and determined by the health plan's medical director to be medically necessary as defined in subsection (b). A health intervention may be medically indicated and not qualify as a covered benefit or meet the definition of medical necessity. A managed care plan may choose to cover health interventions that do not meet the definition of medical necessity.

(b) A health intervention is medically necessary if it is recommended by the treating physician or treating licensed health care provider, is approved by the health plan's medical director or physician designee, and is:

(1) For the purpose of treating a medical condition;

(2) The most appropriate delivery or level of service, considering potential benefits and harms to the patient;

(3) Known to be effective in improving health outcomes; provided that:

(A) Effectiveness is determined first by scientific evidence;

(B) If no scientific evidence exists, then by professional standards of care; and

(C) If no professional standards of care exist or if they exist but are outdated or contradictory, then by expert opinion; and

(4) Cost-effective for the medical condition being treated compared to alternative health interventions, including no intervention. For purposes of this paragraph, cost-effective shall not necessarily mean the lowest price.

(c) When the treating licensed health care provider and the health plan's medical director or physician designee do not agree on whether a health intervention is medically necessary, a reviewing body, whether internal to the plan or external, shall give consideration to, but shall not be bound by, the recommendations of the treating licensed health care provider and the health plan's medical director or physician designee.

(d) For the purposes of this section:

"Cost-effective" means a health intervention where the benefits and harms relative to the costs represent an economically efficient use of resources for patients with the medical condition being treated through the health intervention; provided that the characteristics of the individual patient shall be determinative when applying this criterion to an individual case.

"Effective" means a health intervention that may reasonably be expected to produce the intended results and to have expected benefits that outweigh potential harmful effects.

"Health intervention" means an item or service delivered or undertaken primarily to treat a medical condition or to maintain or restore functional ability. A health intervention is defined not only by the intervention itself, but also by the medical condition and patient indications for which it is being applied. New interventions for which clinical trials have not been conducted and effectiveness has not been scientifically established shall be evaluated on the basis of professional standards of care or expert opinion. For existing interventions, scientific evidence shall be considered first and, to the greatest extent possible, shall be the basis for determinations of medical necessity. If no scientific evidence is available, professional standards of care shall be considered. If professional standards of care do not exist or are outdated or contradictory, decisions about existing interventions shall be based on expert opinion. Giving priority to scientific evidence shall not mean that coverage of existing interventions shall be denied in the absence of conclusive scientific evidence. Existing interventions may meet the definition of medical necessity in the absence of scientific evidence if there is a strong conviction of effectiveness and benefit expressed through up-to-date and consistent professional standards of care, or in the absence of such standards, convincing expert opinion.

"Health outcomes" mean outcomes that affect health status as measured by the length or quality of a patient's life, primarily as perceived by the patient.

"Medical condition" means a disease, illness, injury, genetic or congenital defect, pregnancy, or a biological or psychological condition that lies outside the range of normal, age-appropriate human variation.

"Physician designee" means a physician or other health care practitioner designated to assist in the decision-making process who has training and credentials at least equal to the treating licensed health care provider.

"Scientific evidence" means controlled clinical trials that either directly or indirectly demonstrate the effect of the intervention on health outcomes. If controlled clinical trials are not available, observational studies that demonstrate a causal relationship between the intervention and the health outcomes may be used. Partially controlled observational studies and uncontrolled clinical series may be suggestive, but do not by themselves demonstrate a causal relationship unless the magnitude of the effect observed exceeds anything that could be explained either by the natural history of the medical condition or potential experimental biases. Scientific evidence may be found in the following and similar sources:

(1) Peer-reviewed scientific studies published in or accepted for publication by medical journals that meet nationally recognized requirements for scientific manuscripts and that submit most of their published articles for review by experts who are not part of the editorial staff;

(2) Peer-reviewed literature, biomedical compendia, and other medical literature that meet the criteria of the National Institutes of Health's National Library of Medicine for indexing in Index Medicus, Excerpta Medicus (EMBASE), Medline, and MEDLARS database Health Services Technology Assessment Research (HSTAR);

(3) Medical journals recognized by the Secretary of Health and Human Services under section 1861(t)(2) of the Social Security Act, as amended;

(4) Standard reference compendia including the American Hospital Formulary Service-Drug Information, American Medical Association Drug Evaluation, American Dental Association Accepted Dental Therapeutics, and United States Pharmacopoeia-Drug Information;

(5) Findings, studies, or research conducted by or under the auspices of federal agencies and nationally recognized federal research institutes including but not limited to the Federal Agency for Health Care Policy and Research, National Institutes of Health, National Cancer Institute, National Academy of Sciences, Centers for Medicare and Medicaid Services, Congressional Office of Technology Assessment, and any national board recognized by the National Institutes of Health for the purpose of evaluating the medical value of health services; and

(6) Peer-reviewed abstracts accepted for presentation at major medical association meetings.

"Treat" means to prevent, diagnose, detect, provide medical care, or palliate.

"Treating licensed health care provider" means a licensed health care provider who has personally evaluated the patient. [L 2000, c 250, §8; am L 2011, c 43, §18]
Haw. Rev. Stat. § 435E-18 — HI Code / Division 2 / Title 24 / Chapter 435E / Section 435E-18
Withdrawal of corpus.
Status: in_force

Withdrawal of all, or any portion of, the corpus of the reserve trust fund shall be upon the written authorization signed by at least two-thirds of the members of the board of trustees.
Haw. Rev. Stat. § 431N-8 — HI Code / Division 2 / Title 24 / Chapter 431N / Section 431N-8
Severability.
Status: in_force

If any provision of this chapter, or the application thereof to any person or circumstance is held invalid, the invalidity shall not affect other provisions or applications of this chapter which can be given effect without the invalid provision or application, and to this end the provisions of this chapter are severable.
Haw. Rev. Stat. § 435E-20 — HI Code / Division 2 / Title 24 / Chapter 435E / Section 435E-20
Death of member.
Status: in_force

In the event a participating member who is in full compliance with the trust agreement dies, the initial contribution made by the decedent shall be returned to the member's estate or designated beneficiary; the indemnity coverage shall continue for the benefit of the decedent's estate in respect of occurrences during the time the decedent was a participating member; and neither the person receiving the repayment of the initial contribution nor the decedent's estate shall be responsible for any assessments levied following the death of the member.
Haw. Rev. Stat. § 432E-39 — HI Code / Division 2 / Title 24 / Chapter 432E / Section 432E-39
[ §432E-39] Minimum qualifications for independent review organizations.
Status: in_force

[ §432E-39] Minimum qualifications for independent review organizations. (a) To be eligible for approval under this part to conduct external reviews, an independent review organization shall have and maintain written policies and procedures that govern all aspects of both the standard external review process and the expedited external review process set forth in this part that include, at minimum:

(1) A quality assurance mechanism in place that ensures:

(A) That external reviews are conducted within the specified time frames of this part and required notices are provided in a timely manner;

(B) The selection of qualified and impartial clinical reviewers to conduct external reviews on behalf of the independent review organization and suitable matching of reviewers to specific cases; provided that an independent review organization shall employ or contract with an adequate number of clinical reviewers to meet this objective;

(C) Confidentiality of medical and treatment records and clinical review criteria; and

(D) That any person employed by or under contract with the independent review organization complies with the requirements of this part;

(2) Toll-free telephone, facsimile, and e-mail capabilities to receive information related to external reviews twenty-four hours a day, seven days per week that are capable of accepting, recording, or providing appropriate instruction to incoming telephone callers during other than normal business hours and facilitating necessary communication under this part; and

(3) An agreement to maintain and provide to the commissioner the information required by this part.

(b) Each clinical reviewer assigned by an independent review organization to conduct an external review shall be a physician or other appropriate health care provider who:

(1) Is an expert in the treatment of the medical condition that is the subject of the external review;

(2) Is knowledgeable about the recommended health care service and treatment through recent or current actual clinical experience treating patients with the same or similar medical condition at issue in the external review;

(3) Holds a non-restricted license in a state of the United States and, for physicians, a current certification by a recognized American Medical Specialty Board in the area or areas appropriate to the subject of the external review; and

(4) Has no history of disciplinary actions or sanctions, including loss of staff privileges or participation restrictions, imposed or pending by any hospital, governmental agency or unit, or regulatory body that raises a substantial question as to the clinical reviewer's physical, mental, or professional competence or moral character.

(c) An independent review organization shall not own or control, be a subsidiary of, or in any way be owned or controlled by, or exercise control over a health carrier, health benefit plan, a national, state, or local trade association of health benefit plans, or a national, state, or local trade association of health care providers.

(d) To be eligible to conduct an external review of a specified case, neither the independent review organization selected to conduct the external review nor any clinical reviewer assigned by the independent review organization to conduct the external review shall have a material professional, familial, or financial conflict of interest with any of the following:

(1) The health carrier that is the subject of the external review;

(2) The enrollee whose treatment is the subject of the external review, the enrollee's appointed representative, or the enrollee's immediate family;

(3) Any officer, director, or management employee of the health carrier that is the subject of the external review;

(4) The health care provider, the health care provider's medical group, or independent practice association recommending the health care service or treatment that is the subject of the external review;

(5) The facility at which the recommended health care service or treatment would be provided;

(6) The developer or manufacturer of the principal drug, device, procedure, or other therapy recommended for the enrollee whose treatment is the subject of the external review; or

(7) The health benefit plan that is the subject of the external review, the plan administrator, or any fiduciary or employee of the plan.

The commissioner may determine that no material professional, familial, or financial conflict of interest exists based on the specific characteristics of a particular relationship or connection that creates an apparent professional, familial, or financial conflict of interest.

(e) An independent review organization that is accredited by a nationally-recognized private accrediting entity that has independent review accreditation standards that the commissioner has determined are equivalent to or exceed the minimum qualifications of this section shall be presumed to be in compliance with this section to be eligible for approval under this part.

The commissioner shall review, initially upon approval of an accredited independent review organization and periodically during the time that the independent review organization remains approved pursuant to this section, the accreditation standards of the nationally-recognized private accrediting entity to determine whether the entity's standards are, and continue to be equivalent to, or exceed the minimum qualifications established under this section; provided that a review conducted by the National Association of Insurance Commissioners shall satisfy the requirements of this section.

Upon request of the commissioner, a nationally-recognized private accrediting entity shall make its current independent review organization accreditation standards available to the commissioner or the National Association of Insurance Commissioners in order for the commissioner to determine if the entity's standards are equivalent to or exceed the minimum qualifications established under this section. The commissioner may exclude any private accrediting entity that is not reviewed by the National Association of Insurance Commissioners.

(f) An independent review organization shall establish and maintain written procedures to ensure that it is unbiased in addition to any other procedures required under this section. [L 2011, c 230, pt of §2]
Haw. Rev. Stat. § 432G-4 — HI Code / Division 2 / Title 24 / Chapter 432G / Section 432G-4
Annual reports.
Status: in_force

(a) Each dental insurer shall file with the commissioner:

(1) An audit, by an independent certified public accountant or an accounting firm designated by the dental insurer of the financial statements, reporting the financial condition and results of operations of the dental insurer, annually on or before June 1, or a later date as the commissioner upon request or for cause may specify. The dental insurer, on an annual basis and prior to the commencement of the audit, shall notify the commissioner in writing of the name and address of the person or firm retained to conduct the annual audit. The commissioner may disapprove the dental insurer's designation within fifteen days of receipt of the dental insurer's notice, and the dental insurer shall be required to designate another independent certified public accountant or accounting firm;

(2) A list of the providers who have executed a contract that complies with section 432G‑6(d), annually on or before March 1; and

(3) A description of the available grievance procedures, the total number of grievances handled through those procedures, a compilation of the causes underlying those grievances, and a summary of the final disposition of those grievances, annually on or before March 1.

(b) The commissioner may require additional reports as are deemed necessary and appropriate to enable the commissioner to carry out the commissioner's duties under this chapter.

(c) Any dental insurer failing or refusing to submit any of the documents required under this section shall be liable for a penalty in an amount not less than $100 and not more than $500 for each day of delinquency. Penalties collected pursuant to this section shall be deposited into the compliance resolution fund. [L 2013, c 191, pt of §1]
Haw. Rev. Stat. § 432G-19 — HI Code / Division 2 / Title 24 / Chapter 432G / Section 432G-19
Coordination of benefits.
Status: in_force

(a) Dental insurers are required to adopt provisions for coordination of benefits to avoid overinsurance and to provide for the orderly payment of claims when a person is covered by two or more group health insurance or health care plans.

(b) Provisions adopted pursuant to subsection (a) for the coordination of benefits shall be consistent with the coordination of benefits provisions that are in general use in the State for coordinating coverage between two or more group health insurance or health care plans. [L 2013, c 191, pt of §1]
Haw. Rev. Stat. § 431K-3 — HI Code / Division 2 / Title 24 / Chapter 431K / Section 431K-3
Risk retention groups not chartered in this State.
Status: in_force

Risk retention groups chartered in states other than this State and seeking to do business as a risk retention group in this State shall observe and abide by the laws of this State as follows:

(1) Before offering insurance in this State, a risk retention group shall submit to the commissioner:

(A) A statement identifying the state or states in which the risk retention group is chartered and licensed as a liability insurance company, date of chartering, its principal place of business, and other information, including information on its membership, as the commissioner of this State may require to verify that the risk retention group is qualified as a risk retention group;

(B) A copy of its plan of operations or a feasibility study and revisions of this plan or study submitted to its state of domicile; provided that the provision relating to the submission of a plan of operation or a feasibility study shall not apply with respect to any line or classification of liability insurance which was:

(i) Defined in the Product Liability Risk Retention Act of 1981, 15 U.S.C. §3901 et seq., before October 27, 1986; and

(ii) Offered before that date by any risk retention group which had been chartered and operating for not less than three years before that date; and

(C) A statement of registration which designates the commissioner as its agent for the purpose of receiving service of legal documents or process;

(2) Any risk retention group doing business in this State shall submit to the commissioner:

(A) A copy of each examination of the risk retention group as certified by the commissioner or public official conducting the examination in its state of domicile;

(B) Upon request by the commissioner, a copy of any audit performed with respect to the risk retention group; and

(C) Information as may be required to verify its continuing qualification as a risk retention group;

(3) Taxation of risk retention groups shall be as follows:

(A) All premiums paid for coverages within this State to risk retention groups shall be subject to taxation at the same rate and subject to the same interest, fines, and penalties for nonpayment as that applicable to risk retention group captives chartered in this State pursuant to chapter 431, article 19;

(B) To the extent producers are utilized, the producers shall report and pay the taxes for the premiums for risks which the producers have placed with or on behalf of a risk retention group not chartered in this State; or

(C) To the extent producers are not utilized or fail to pay the tax, each risk retention group shall pay the tax for risks insured within the State; provided that each risk retention group shall report all premiums paid to it for risks insured within the State;

(4) Any risk retention group shall comply with chapter 431, article 13 regarding deceptive, false, or fraudulent acts or practices, and unfair claims settlement practices; provided that if the commissioner seeks an injunction regarding such conduct, the injunction shall be obtained from a court of competent jurisdiction;

(5) Any risk retention group shall submit to an examination by the commissioner to determine its financial condition if the commissioner of the jurisdiction in which the group is chartered has not initiated an examination or does not initiate an examination within sixty days after a request by the commissioner of this State. Any examination shall be coordinated to avoid unjustified repetition and conducted in an expeditious manner and in accordance with the National Association of Insurance Commissioners' Examiner Handbook;

(6) The following notice shall be printed in ten point type on the front page of every application for insurance from a risk retention group, and on the front page and the declaration page of every policy issued by a risk retention group:

NOTICE

This policy is issued by your risk retention group. Your risk retention group may not be subject to all of the insurance laws and rules of your state. State insurance insolvency guaranty funds are not available for your risk retention group;

(7) The following acts by a risk retention group are prohibited:

(A) The solicitation or sale of insurance by a risk retention group to any person who is not eligible for membership in the group; and

(B) The solicitation or sale of insurance by, or operation of, a risk retention group that is in a hazardous financial condition or is financially impaired;

(8) No risk retention group shall be allowed to do business in this State if an insurance company is directly or indirectly a member or owner of the risk retention group, other than in the case of a risk retention group all of whose members are insurance companies;

(9) No risk retention group may offer insurance policy coverage prohibited by chapter 431 or declared unlawful by the highest court of this State; and

(10) A risk retention group not chartered in this State and doing business in this State shall comply with a lawful order issued in a voluntary dissolution proceeding or in a delinquency proceeding commenced by any state insurance commissioner if there has been a finding of financial impairment after an examination under paragraph (5). [L 1987, c 180, pt of §1; am L 1989, c 272, §4; am L 1993, c 205, §38; am L 2002, c 155, §98; am L 2015, c 63, §8]
Haw. Rev. Stat. § 435E-16 — HI Code / Division 2 / Title 24 / Chapter 435E / Section 435E-16
Payments.
Status: in_force

The income earned on the corpus of the trust fund shall be the source for the payment of the claims, costs, judgments, settlements, and costs of administration contemplated by such interindemnity arrangement, and to the extent such income is insufficient for such purposes, the board of trustees shall have the power and authority to assess participating members for all amounts necessary to meet the obligations of such interindemnity arrangement in accordance with the terms thereof and any such assessment levied against a member shall be the personal obligation of such member. Any person who obtains a final judgment of recovery for medical malpractice against a member of such interindemnity arrangement shall have, in addition to any other remedy, the right to assert directly all rights to indemnification which the judgment debtor has under the interindemnity arrangement. Such final judgment shall be a lien on the reserve trust fund to secure payment of such judgment, limited to the extent of the judgment debtor's rights to indemnification.
Haw. Rev. Stat. § 435E-45 — HI Code / Division 2 / Title 24 / Chapter 435E / Section 435E-45
Refusal to comply.
Status: in_force

In case of contumacy by, or refusal to obey a subpoena issued to, any person, the circuit court, upon application by the commissioner, may issue to the person an order requiring the person to appear before the commissioner or the officer designated by the commissioner, there to produce documentary evidence, if so ordered, or to give evidence touching the matter under investigation or in question. Failure to obey the order of the court shall be punished by the court as a contempt.
Haw. Rev. Stat. § 432E-41 — HI Code / Division 2 / Title 24 / Chapter 432E / Section 432E-41
[ §432E-41] External review reporting requirements.
Status: in_force

[ §432E-41] External review reporting requirements. (a) An independent review organization assigned pursuant to this part to conduct an external review shall maintain written records in the aggregate by state and by health carrier on all requests for external review for which it conducted an external review during a calendar year and upon request shall submit a report to the commissioner, as required under subsection (b).

(b) Each independent review organization required to maintain written records on all requests for external review pursuant to subsection (a) for which it was assigned to conduct an external review shall submit to the commissioner, upon request, a report in the format specified by the commissioner. The report shall include in the aggregate by state, and for each health carrier:

(1) The total number of requests for external review;

(2) The number of requests for external review resolved and, of those resolved, the number resolved upholding the adverse action and the number resolved reversing the adverse action;

(3) The average length of time for resolution;

(4) The summary of the types of coverages or cases for which an external review was sought, as provided in the format required by the commissioner;

(5) The number of external reviews that were terminated as the result of a reconsideration by the health carrier of its adverse action after the receipt of additional information from the enrollee or the enrollee's appointed representative; and

(6) Any other information the commissioner may request or require.

The independent review organization shall retain the written records required pursuant to this subsection for at least three years.

(c) Each health carrier shall maintain written records in the aggregate, by state and for each type of health benefit plan offered by the health carrier on all requests for external review that the health carrier receives notice of from the commissioner pursuant to this part.

Each health carrier required to maintain written records on all requests for external review shall submit to the commissioner, upon request, a report in the format specified by the commissioner that includes in the aggregate, by state, and by type of health benefit plan:

(1) The total number of requests for external review;

(2) From the total number of requests for external review reported, the number of requests determined eligible for a full external review; and

(3) Any other information the commissioner may request or require.

The health carrier shall retain the written records required pursuant to this subsection for at least three years. [L 2011, c 230, pt of §2]
Haw. Rev. Stat. § 432D-23 — HI Code / Division 2 / Title 24 / Chapter 432D / Section 432D-23
Required provisions and benefits.
Status: in_force

Notwithstanding any provision of law to the contrary, each policy, contract, plan, or agreement issued in the State after January 1, 1995, by health maintenance organizations pursuant to this chapter, shall include benefits provided in sections 431:10-212, 431:10A-115, 431:10A-115.5, 431:10A-116, 431:10A-116.2, 431:10A-116.5, 431:10A-116.6, 431:10A-119, 431:10A-120, 431:10A-121, 431:10A-122, 431:10A-125, 431:10A-126, 431:10A-132, 431:10A-133, 431:10A-140, and 431:10A-134, and chapter 431M.
Haw. Rev. Stat. § 432D-25 — HI Code / Division 2 / Title 24 / Chapter 432D / Section 432D-25
Disclosure of health care coverage and benefits.
Status: in_force

In order to ensure that all individuals understand their health care options and are able to make informed decisions, all health maintenance organizations shall provide current and prospective enrollees with written disclosure of coverages and benefits, including information on coverage principles and any exclusions or restrictions on coverage.

The information provided shall be current, understandable, and available prior to enrollment, and upon request after enrollment. A policy or contract provided to an enrollee which describes coverages and benefits shall be in conformance with part I of article 10 of chapter 431. [L 1996, c 274, §3; am L 1999, c 246, §5]
Haw. Rev. Stat. § 432D-9 — HI Code / Division 2 / Title 24 / Chapter 432D / Section 432D-9
Uncovered expenditures insolvency deposit.
Status: in_force

(a) If, at any time, uncovered expenditures exceed ten per cent of total health care expenditures, a health maintenance organization shall place with the commissioner or with any organization or trustee acceptable to the commissioner through which a custodial or controlled account is maintained, an uncovered expenditures insolvency deposit consisting of cash or securities that are acceptable to the commissioner. Such deposit shall have, at all times, a fair market value in an amount of one-hundred-twenty per cent of the health maintenance organization's outstanding liability for uncovered expenditures for enrollees in this State, including incurred but not reported claims, and shall be calculated as of the first day of the month and maintained for the remainder of the month. If a health maintenance organization is not otherwise required to file a quarterly report, it shall file a report within forty-five days of the end of the calendar quarter with information sufficient to demonstrate compliance with this section.

(b) The deposit required under this section is in addition to the deposit required under section 432D-8 and is an admitted asset of the health maintenance organization in the determination of net worth. All income from the deposits or trust accounts shall be assets of the health maintenance organization and may be withdrawn from the deposit or trust account quarterly with the approval of the commissioner.

(c) A health maintenance organization that has made a deposit may withdraw that deposit or any part of the deposit if:

(1) A substitute deposit of cash or securities of equal amount and value is made;

(2) The fair market value exceeds the amount of the required deposit; or

(3) The required deposit under subsection (a) is reduced or eliminated.

Deposits, substitutions, or withdrawals may be made only with the prior written approval of the commissioner.

(d) The deposit required under this section is held in trust and may be used only as provided in this section. The commissioner may use the deposit of an insolvent health maintenance organization for administrative costs associated with administering the deposit and payment of claims of enrollees of this State for uncovered expenditures in this State. Claims for uncovered expenditures shall be paid on a pro rata basis based on assets available to pay such ultimate liability for incurred expenditures. Partial distribution may be made pending final distribution. Any amount of the deposit remaining shall be paid into the liquidation or receivership of the health maintenance organization.

(e) The commissioner may prescribe by rule the time, manner, and form for filing claims under subsection (d).

(f) The commissioner may require by rule or order health maintenance organizations to file annual, quarterly, or more frequent reports as the commissioner deems necessary to demonstrate compliance with this section. The commissioner may require that the reports include liability for uncovered expenditures as well as an audit opinion. [L 1995, c 179, pt of §1; am L 2003, c 212, §127]
Haw. Rev. Stat. § 435C-8 — HI Code / Division 2 / Title 24 / Chapter 435C / Section 435C-8
Privileged communications.
Status: in_force

There shall be no liability on the part of, and no cause of action of any nature shall arise against the plan, its agents or employees, an insurer, any producer, or the insurance commissioner or the commissioner's authorized representatives, for any statements made in good faith by them in any reports or communications concerning risks insured or to be insured by the plan, or at any administrative hearing conducted in connection therewith.
Haw. Rev. Stat. § 431P-20 — HI Code / Division 2 / Title 24 / Chapter 431P / Section 431P-20
Temporary recording fee; establishment, reduction, and cessation by board.
Status: in_force

(a) Subject to the approval of the commissioner, the board may activate, reduce, or terminate the collection of a temporary recording fee as provided in this section.

(b) The temporary recording fee shall be imposed on each document that is recorded with the bureau of conveyances or filed with the assistant registrar of the land court of the State.

(c) If the board establishes or reactivates the temporary recording fee, the board shall:

(1) Set the amount of the fee; provided that the amount shall not exceed $44 per document recorded with the bureau of conveyances or filed with the assistant registrar of the land court of the State; and

(2) Establish the period of time during which the fee shall be collected; provided that the time period shall not exceed thirty-six months.

(d) The temporary recording fee shall not apply to documents recorded or filed for parcels in the agricultural land use district pursuant to section 205-2.

(e) Notwithstanding the amount or time period established under subsection (c)(1) or (2), the board at any time may:

(1) Reduce the amount of the temporary recording fee; or

(2) Terminate the collection of the temporary recording fee.

(f) The temporary recording fee shall be submitted to and collected by the bureau of conveyances or the assistant registrar of the land court of the State. All proceeds realized from the collection of the fee shall be deposited into a separate account of the hurricane reserve trust fund.

(g) The temporary recording fee shall be in addition to any applicable fees under chapter 501 or 502. [L 2025, c 296, pt of §8]
Haw. Rev. Stat. § 431C-32 — HI Code / Division 2 / Title 24 / Chapter 431C / Section 431C-32
Disclosure to insurer.
Status: in_force

(a) Without limiting the ability of an insurer from assessing the insurability of a policy applicant and determining whether or not to issue the policy, and in addition to other questions an insurance carrier may lawfully pose to a life insurance applicant, insurance carriers may inquire in the application for insurance whether the proposed owner intends to pay premiums with the assistance of financing from a lender that will use the policy as collateral to support the financing.

(b) If, as described in subsection (a)(3) of the definition of "life settlement contract" in section 431C-2, a loan provides funds that can be used for a purpose other than paying for the premiums, costs, and expenses associated with obtaining and maintaining the policy and loan, the application shall be rejected as a violation of the prohibited practices in section 431C-41.

(c) If the financing does not violate section 431C-41 in this manner, the insurance carrier:

(1) May make disclosures to the applicant and the insured, either on the application or an amendment to the application to be completed no later than the delivery of the policy, including the following:

"If you have entered into a loan arrangement where the policy is used as collateral, and the policy does change ownership at some point in the future in satisfaction of the loan, the following may be true:

(1) A change of ownership could lead to a stranger owning an interest in the insured's life;

(2) A change of ownership could in the future limit your ability to purchase future insurance on the insured's life because there is a limit to how much coverage insurers will issue on one life;

(3) Should there be a change of ownership and you wish to obtain more insurance coverage on the insured's life in the future, the insured's higher issue age, a change in health status, and/or other factors may reduce the ability to obtain coverage and/or may result in significantly higher premiums;

(4) You should consult a professional advisor, since a change in ownership in satisfaction of the loan may result in tax consequences to the owner, depending on the structure of the loan"; and

(2) May require certifications, such as the following, from the applicant or the insured:

"(1) I have not entered into any agreement or arrangement providing for the future sale of this life insurance policy;

(2) My loan arrangement for this policy provides funds sufficient to pay for some or all of the premiums, costs, and expenses associated with obtaining and maintaining my life insurance policy, but I have not entered into any agreement by which I am to receive consideration in exchange for procuring this policy; and

(3) The borrower has an insurable interest in the insured." [L 2012, c 256, pt of §1]
Haw. Rev. Stat. § 432D-24 — HI Code / Division 2 / Title 24 / Chapter 432D / Section 432D-24
Coordination of benefits.
Status: in_force

(a) Health maintenance organizations are permitted, but not required to adopt provisions for coordination of benefits to avoid overinsurance and to provide for the orderly payment of claims when a person is covered by two or more group health insurance or health care plans.

(b) If health maintenance organizations adopt provisions for coordination of benefits, the provisions must be consistent with the coordination of benefits provisions that are in general use in the State for coordinating coverage between two or more group health insurance or health care plans. [L 1995, c 179, pt of §1]
Haw. Rev. Stat. § 432G-15 — HI Code / Division 2 / Title 24 / Chapter 432G / Section 432G-15
Administrative fines and enforcement.
Status: in_force

(a) The commissioner, in addition to or in lieu of suspension or revocation of a certificate of authority pursuant to section 432G‑13, may levy an administrative fine upon a dental insurer in an amount not less than $500 and not more than $50,000. The dental insurer may request, in writing, a hearing pursuant to section 432G‑13. The order levying the fine shall specify the period within which the fine shall be fully paid, which shall not be less than thirty nor more than forty-five days from the date of the order. Upon failure to pay the fine when due, the commissioner shall revoke the insurer's certificate of authority if not already revoked, and the fine shall be recovered in a civil action brought on behalf of the commissioner. Any fine so collected shall be remitted by the commissioner to the director of finance and shall be placed to the credit of the compliance resolution fund.

(b) If the commissioner, for any reason, has cause to believe that any violation of this chapter has occurred or is threatened, the commissioner may give notice to a dental insurer and its representatives, or other persons who appear to be involved in such suspected violation, to arrange a conference with the alleged violators or their authorized representatives for the purpose of attempting to ascertain the facts relating to any suspected violation. In the event it appears that any violation has occurred or is threatened, the commissioner may attempt to arrive at an adequate and effective means of correcting or preventing the violation. Proceedings under this subsection shall not be governed by any formal procedural requirements and may be conducted in such manner as the commissioner may deem appropriate under the circumstances. However, unless consented to by the dental insurer, no order may result from a conference until the requirements of this section are satisfied.

(c) The commissioner may issue an order directing a dental insurer or a representative of a dental insurer to cease and desist from engaging in any act or practice in violation of the provisions of this chapter. Any person aggrieved by an order of the commissioner under this section may obtain judicial review of the order in the manner provided for by chapter 91.

(d) In the case of any violation of the provisions of this chapter, if the commissioner elects not to issue a cease and desist order, or in the event of noncompliance with a cease and desist order issued pursuant to subsection (c), the commissioner may institute a proceeding to obtain injunctive or other appropriate relief in any court of competent jurisdiction. [L 2013, c 191, pt of §1]
Haw. Rev. Stat. § 431P-15 — HI Code / Division 2 / Title 24 / Chapter 431P / Section 431P-15
Exemption from property and liability insurance guaranty association; insolvency of fund.
Status: in_force

Notwithstanding any other provision of law to the contrary, neither the fund nor its policyholders shall be subject to the provisions of, or be eligible for, the benefits provided in sections 431:16-101 to 117 inclusive. If the total amount available at any time to the fund is insufficient to make all necessary payments, the moneys available shall be prorated and the unpaid portion shall be paid as soon thereafter as moneys become available.
Haw. Rev. Stat. § 431K-8 — HI Code / Division 2 / Title 24 / Chapter 431K / Section 431K-8
Restrictions on insurance purchased by purchasing groups.
Status: in_force

(a) A purchasing group located in this State may not purchase insurance from:

(1) A risk retention group that is not chartered in this State; or

(2) An insurer not authorized in this State,

unless the purchase is made through a licensed producer acting pursuant to the surplus lines laws set forth in article 8 of chapter 431.

(b) The terms of any liability insurance policy obtained by a purchasing group shall not provide nor be construed to provide insurance coverage prohibited by chapter 431 or declared unlawful by the highest court of this State.

(c) A purchasing group which obtains liability insurance from an insurer not authorized in this State or a risk retention group shall inform each of the members of the group which have a risk resident or located in this State that the risk retention group or insurer may not be subject to any insurance laws of this State.

(d) No purchasing group may purchase insurance providing for a deductible or self-insured retention unless the deductible or self-insured retention shall be the sole responsibility of each individual member of the purchasing group. [L 1987, c 180, pt of §1; am L 1989, c 272, §7; am L 1998, c 76, §1; am L 2002, c 155, §100; am L 2006, c 154, §42]
Haw. Rev. Stat. § 432E-38 — HI Code / Division 2 / Title 24 / Chapter 432E / Section 432E-38
[ §432E-38] Approval of independent review organizations.
Status: in_force

[ §432E-38] Approval of independent review organizations. (a) An independent review organization shall be approved by the commissioner in order to be eligible to be assigned to conduct external reviews under this part.

(b) To be eligible for approval by the commissioner to conduct external reviews under this part an independent review organization shall:

(1) Submit an application on a form required by the commissioner and include all documentation and information necessary for the commissioner to determine if the independent review organization satisfies the minimum qualifications established under this part; and

(2) Except as otherwise provided in subsection (c), shall be accredited by a nationally-recognized private accrediting entity that the commissioner has determined has independent review organization accreditation standards that are equivalent to or exceed the minimum standards established by this section and section 432E-39.

(c) The commissioner may approve independent review organizations that are not accredited by a nationally-recognized private accrediting entity if there are no acceptable nationally-recognized private accrediting entities providing independent review organization accreditation.

(d) The commissioner may charge an application fee that the independent review organizations shall submit to the commissioner with an application for approval and re-approval.

(e) Approval pursuant to this section is effective for two years, unless the commissioner determines before its expiration that the independent review organization does not meet the minimum qualifications established under this part. If the commissioner determines that an independent review organization has lost its accreditation or no longer satisfies the minimum requirements of this part, the commissioner shall terminate the approval of the independent review organization and remove the independent review organization from the list of independent review organizations approved to conduct external reviews maintained by the commissioner.

(f) The commissioner shall maintain and periodically update a list of approved independent review organizations. [L 2011, c 230, pt of §2]
Haw. Rev. Stat. § 432D-9.5 — HI Code / Division 2 / Title 24 / Chapter 432D / Section 432D-9.5
Reserve credit for reinsurance.
Status: in_force

Any health maintenance organization that takes credit for reserves on risks ceded to a reinsurer shall be subject to provisions of chapter 431 related to credit for reinsurance.
Haw. Rev. Stat. § 431K-3.5 — HI Code / Division 2 / Title 24 / Chapter 431K / Section 431K-3.5
Registration fees and service fees of risk retention groups not chartered in this State.
Status: in_force

(a) A risk retention group chartered in states other than this State and seeking to do business as a risk retention group in this State shall pay an initial registration fee of $300 to the commissioner and shall thereafter pay annually a service fee of $150 on or before the extension date of the certificate of authority, as established pursuant to section 431:3-214. The commissioner may, upon showing of good cause, waive or modify, in whole or part, all fees in this subsection by order.

(b) If the service fee is not paid on or before the extension date, a penalty shall be imposed in the amount of fifty per cent of the service fee. The commissioner shall provide written notice of the delinquency of payment and the imposition of the authorized penalty. If the service fee and the penalty are not paid within thirty days immediately following the date of the notice of delinquency, the commissioner may revoke the registration of the risk retention group and may not reinstate the registration until the service fee and the penalty have been paid. [L 2015, c 63, pt of §1; am L 2021, c 110, §15]
Haw. Rev. Stat. § 431C-52 — HI Code / Division 2 / Title 24 / Chapter 431C / Section 431C-52
Conflict of laws.
Status: in_force

(a) If there is more than one owner of a single policy, and the owners are residents of different states, the life settlement contract shall be governed by the law of the state in which the owner having the largest percentage ownership resides or, if the owners hold equal ownership, the state of residence of one owner agreed upon in writing by all of the owners. The law of the state of the insured shall govern in the event that equal owners fail to agree in writing upon a state of residence for jurisdictional purposes.

(b) A provider from this State who enters into a life settlement contract with an owner who is a resident of another state that has enacted statutes or adopted regulations governing life settlement contracts, shall be governed in the effectuation of that life settlement contract by the statutes and regulations of the owner's state of residence. If the state in which the owner is a resident has not enacted statutes or regulations governing life settlement contracts, the provider shall give the owner notice that neither that state nor this State regulates the transaction upon which the owner is entering. For transactions in those states, however, the provider shall maintain all records required if the transactions were executed in the state of residence. The forms used in those states need not be approved by the insurance division.

(c) If there is a conflict in the laws that apply to an owner and a purchaser in any individual transaction, the laws of the state that apply to the owner shall take precedence and the provider shall comply with those laws. [L 2012, c 256, pt of §1]
Haw. Rev. Stat. § 435E-25 — HI Code / Division 2 / Title 24 / Chapter 435E / Section 435E-25
Voluntary termination of a member.
Status: in_force

A participating member who is then in full compliance with the trust agreement may elect voluntarily to terminate the participating member's membership in the interindemnity arrangement. Upon voluntary termination, the person may further elect to cease being responsible for future assessments, or to continue to pay the assessments until the person's initial contribution is repaid. If the person elects to cease being responsible for future assessments, the indemnity coverage shall thereupon terminate and the person shall either be responsible for the person's own exposure for acts committed while a participating member in the interindemnity arrangement, or the person may request the interindemnity arrangement to purchase or provide, at the cost of the person, coverage for the person's exposure. The initial contribution of the person shall be repaid on the tenth anniversary of the date the contribution was made. If the person elects to continue to be responsible for assessments, the indemnity coverage shall continue in respect of occurrences prior to the date of the voluntary termination, and the initial contribution of the person shall be repaid when the board of trustees is satisfied that:

(1) There are no claims pending against the person in respect of occurrences during the time the person was a participating member; and

(2) The statute of limitations has run on all claims that might be asserted against the person in respect of occurrences during that time.

In no event shall repayment be made earlier than the tenth anniversary of the date the contribution was made. [L 1977, c 182, pt of §1; am L 2018, c 18, §30]
Haw. Rev. Stat. § 435C-11 — HI Code / Division 2 / Title 24 / Chapter 435C / Section 435C-11
Initiation of plan.
Status: in_force

The plan becomes operational at the direction of the insurance commissioner, upon a finding that medical malpractice insurance is not or will not be readily available in this State to the majority of the physicians and hospitals. Upon a finding by the insurance commissioner that medical malpractice insurance has become readily available in the voluntary market, the commissioner may direct the plan to cease writing medical malpractice insurance.

The plan, being a temporary measure, shall not remain in existence for more than three years after the plan becomes operational. [L 1975, c 161, pt of §1; gen ch 1985]
Haw. Rev. Stat. § 431C-34 — HI Code / Division 2 / Title 24 / Chapter 431C / Section 431C-34
Buyer's guide.
Status: in_force

The commissioner by rule shall require delivery of a buyer's guide or a similar consumer advisory package to owners during the process of soliciting a life settlement contract.
Haw. Rev. Stat. § 435C-9 — HI Code / Division 2 / Title 24 / Chapter 435C / Section 435C-9
Annual statements.
Status: in_force

The plan shall file in the office of the insurance commissioner annually on or before the fifteenth day of March, a statement which shall contain information with respect to its transactions, conditions, operations and affairs during the preceding year. Such statement shall contain such matters and information as are prescribed and shall be in such form as is approved by the insurance commissioner. The insurance commissioner may, at any time, require the plan to furnish additional information with respect to its transactions, condition, or any matter connected therewith considered to be material and of assistance in evaluating the scope, operation and experience of the plan.
Haw. Rev. Stat. § 432E-43 — HI Code / Division 2 / Title 24 / Chapter 432E / Section 432E-43
[ §432E-43] Disclosure requirements.
Status: in_force

[ §432E-43] Disclosure requirements. (a) Each health carrier shall include a description of the external review procedures in or attached to the policy, certificate, membership booklet, outline of coverage, or other evidence of coverage it provides to enrollees.

(b) Disclosure shall be in a format prescribed by the commissioner and shall include a statement informing the enrollee of the right of the enrollee to file a request for an external review of an adverse action with the commissioner. The statement may explain that external review is available when the adverse action involves an issue of medical necessity, appropriateness, health care setting, level of care, or effectiveness. The statement shall include the telephone number and address of the commissioner.

(c) In addition to the requirements of subsection (b), the statement shall inform the enrollee that, when filing a request for an external review, the enrollee or the enrollee's appointed representative shall be required to authorize the release of any medical records of the enrollee that may be required to be reviewed for the purpose of reaching a decision on the external review and shall be required to provide written disclosures to permit the commissioner to perform a conflict of interest evaluation for selection of an appropriate independent review organization.

(d) Each health carrier shall have available on its website and provide upon request to any enrollee, forms for the purpose of requesting an external review, which shall include an authorization release form that complies with the federal Health Insurance Portability and Accountability Act as well as a disclosure form for conflict of interest evaluation purposes that shall include the name of the enrollee, any authorized representative acting on behalf of the enrollee, the enrollee's immediate family members, the health carrier that is the subject of the external review, the health benefit plan, the plan administrator, plan fiduciaries and plan employees if the enrollee is in a group health benefits plan, the health care providers treating the enrollee for purposes of the condition that is the subject of the external review and the providers' medical groups, the health care provider and facility at which the requested health care service or treatment would be provided, and the developer or manufacturer of the principal drug, device, procedure, or other therapy that is the subject of the external review request.

(e) Each health carrier doing business in Hawaii shall file with the commissioner by the effective date of this part, information to permit the commissioner to perform a conflict of interest evaluation for selection of an appropriate independent review organization in the event of a request for external review involving the health carrier. A filing pursuant to this section shall include the name of the health carrier, its officers, directors, and management employees. The health carrier shall promptly amend its filing with the commissioner when there is any change of officers, directors, or managing employees.

(f) The commissioner may prescribe the form or format to use for the release authorization required by subsection (d) and the conflict of interest disclosures required by subsections (d) and (e).

(g) No disclosure required for purposes of this part shall include lawyer-client privileged communications protected pursuant to the Hawaii rules of evidence rule 503. [L 2011, c 230, pt of §2]
Haw. Rev. Stat. § 431L-5 — HI Code / Division 2 / Title 24 / Chapter 431L / Section 431L-5
Recoupment of amounts spent on child medical care.
Status: in_force

The department of the attorney general may garnish the wages, salary, or other employment income of, and withhold amounts from state tax refunds to, any person who:

(1) Is required by court or administrative order to provide coverage of the cost of health services to a child eligible for medical assistance under medicaid; and

(2) Has received payment from a third party for the costs of such services but has not used the payments to reimburse either the other parent or guardian of the child or the provider of the services,

to the extent necessary to reimburse the department of human services for its costs, but claims for current and past due child support shall take priority over these claims. [L 1995, c 83, pt of §2]
Haw. Rev. Stat. § 431R-4 — HI Code / Division 2 / Title 24 / Chapter 431R / Section 431R-4
Report to insurance commissioner.
Status: in_force

(a) No later than March 31 of each calendar year, each prescription drug benefit plan, health benefits plan under chapter 87A, and pharmacy benefit manager shall file with the insurance commissioner, in such form and detail as the insurance commissioner shall prescribe, a report for the preceding calendar year stating that the pharmacy benefit manager or prescription drug benefit plan is in compliance with this chapter. The report shall fully disclose the amount, terms, and conditions relating to copayments, reimbursement options, and other payments associated with a prescription drug benefit plan.

(b) The insurance commissioner shall review and examine records supporting the accuracy and completeness of the report and, no later than ninety days after the receipt of the report, shall make available to a purchaser of a prescription drug benefit plan and to any retail community pharmacy participating in a retail pharmacy network under section 431R-2 that provides benefits to beneficiaries of a prescription drug benefit plan a summary of the amount, terms, and conditions relating to copayments, reimbursement options, and other payments associated with a prescription drug benefit plan. [L 2013, c 226, pt of §2]
Haw. Rev. Stat. § 431P-3 — HI Code / Division 2 / Title 24 / Chapter 431P / Section 431P-3
Board of directors.
Status: in_force

(a) The board of directors of the fund shall consist of the insurance commissioner as an ex officio voting member and six members appointed by the governor in accordance with section 26-34. The board shall be the policy making body of the fund. As such, the board shall be responsible for establishing policies for the administration and operation of the fund and the performance of other duties and functions assigned to the fund.

(b) Two members shall, by and with the advice and consent of the senate, be appointed by the governor for a term of four years; provided that of the initial appointees, one shall be appointed for a two-year term. A vacancy on the authority of a seat subject to this subsection shall be filled in accordance with Article V, section 6, of the Constitution of the State of Hawaii.

(c) Two members shall, by and with the advice and consent of the senate, be appointed by the governor from a list of nominations submitted by the president of the senate. The members appointed from a list of nominations of the president of the senate shall serve for a term of four years; provided that of the initial appointees, one shall be appointed for a two-year term.

(d) Two members shall, by and with the advice and consent of the senate, be appointed by the governor from a list of nominations submitted by the speaker of the house of representatives. The members appointed from a list of nominations of the speaker of the house of representatives shall serve for a term of four years; provided that of the initial appointees, one shall be appointed for a two-year term.

(e) The governor shall select a chairperson and vice-chairperson from among the members.

(f) The board shall meet as often as necessary to formulate and implement strategies and plans of operation in furtherance of this chapter. Upon its appointment, the board shall adopt an interim plan of operation within ninety days.

(g) The appointed directors shall receive no compensation for services, but shall be entitled to reimbursement of necessary expenses, including travel expenses, incurred in the performance of their duties.

(h) The board may appoint, not subject to chapter 76, an executive director of the fund whose salary shall be set by the board. The board may employ, not subject to chapter 76, technical experts and officers, agents, and employees, permanent or temporary, as required. The board may also contract with persons, not subject to chapters 76 and 78 when in the determination of the board, the services to be performed are unique and essential to the execution of the functions of the fund. [L 1993, c 339, pt of §2; am L 1998, c 106, §3; am L 2000, c 253, §150; am L 2005, c 22, §29]
Haw. Rev. Stat. § 431P-4 — HI Code / Division 2 / Title 24 / Chapter 431P / Section 431P-4
Planning and assessment functions of the fund; discretion to provide insurance.
Status: in_force

(a) The fund shall be responsible for monitoring the availability of property insurance, including insurance for covered events, in this State. If at any time the board determines, in its sole discretion, that the private insurance market is not making such insurance reasonably available to consumers in this State, the fund may offer policies of hurricane property insurance for sale in accordance with this chapter.

(b) Nothing in subsection (a) shall prohibit the board from exercising its powers to develop plans and procedures for the operation and management of the fund without regard to the determination of the board as to the availability of insurance in the private market. [L 1993, c 339, pt of §2]
Haw. Rev. Stat. § 431K-6 — HI Code / Division 2 / Title 24 / Chapter 431K / Section 431K-6
Purchasing groups; exemption from certain laws relating to the group purchase of insurance.
Status: in_force

A purchasing group meeting the criteria established under the provisions of the Federal Liability Risk Retention Act of 1986, P.L. 99-563, shall be exempt from any law of this State relating to the creation of groups for the purchase of insurance, prohibition of group purchasing or any law that would discriminate against a purchasing group or its members. In addition, an insurer shall be exempt from any law of this State which prohibits providing, or offering to provide, to a purchasing group or its members advantages based on their loss and expense experience not afforded to other persons with respect to rates, policy forms, coverages or other matters. A purchasing group shall be subject to all other applicable laws of this State.
Haw. Rev. Stat. § 432D-6 — HI Code / Division 2 / Title 24 / Chapter 432D / Section 432D-6
Information to enrollees or subscribers.
Status: in_force

(a) The health maintenance organization shall provide to its subscribers a list of providers and participating providers, upon enrollment and reenrollment.

(b) Every health maintenance organization shall provide to its subscribers notice of any material change in the operation of the organization that will affect them directly within thirty days of the material change.

(c) The health maintenance organization shall provide to subscribers information on how services may be obtained, where additional information on access to services may be obtained, a description of the internal grievance procedures, and a telephone number for the enrollee to contact the health maintenance organization at no cost to the enrollee.

(d) For the purpose of this section "material change" means any major change in provider or participating provider agreements. [L 1995, c 179, pt of §1]
Haw. Rev. Stat. § 431M-1 — HI Code / Division 2 / Title 24 / Chapter 431M / Section 431M-1
Definitions.
Status: in_force

Whenever used in this chapter, unless the context otherwise requires:

"Advanced practice registered nurse" means a person licensed pursuant to chapter 457.

"Alcohol dependence" means any use of alcohol which produces a pattern of pathological use causing impairment in social or occupational functioning or produces physiological dependency evidenced by physical tolerance or withdrawal.

"Alcohol or drug dependence outpatient services" means alcohol or drug dependence nonresidential treatment provided on an ambulatory basis to patients with alcohol or drug dependence problems that includes interventions prescribed and performed by qualified physicians, psychologists, licensed clinical social workers, licensed marriage and family therapists, licensed mental health [counselors], or advanced practice registered nurses. This definition shall not imply a broadening of the scope of or granting of prescriptive authority privileges, except as otherwise allowed pursuant to chapter 457.

"Certified substance abuse counselor" means a person who is certified pursuant to section 321-193.

"Day treatment services" means treatment services provided by a hospital, mental health outpatient facility, or nonhospital facility to patients who, because of their conditions, require more than periodic hourly service. Day treatment services shall be prescribed by a physician, psychologist, licensed clinical social worker, licensed marriage and family therapist, licensed mental health counselor, or advanced practice registered nurse, and carried out under the supervision of a physician, psychologist, licensed clinical social worker, licensed marriage and family therapist, licensed mental health counselor, or advanced practice registered nurse. Day treatment services require less than twenty-four hours of care and a minimum of three hours in any one day.

"Detoxification services" means the process whereby a person intoxicated by alcohol, drugs, or both, or a person who is dependent upon alcohol, drugs, or both, is assisted through the period of time necessary to eliminate, by metabolic or other means, the intoxicating alcohol or drug dependency factors, as determined by a physician or advanced practice registered nurse, while keeping the physiological risk to the person at a minimum.

"Drug dependence" means any pattern of pathological use of drugs causing impairment in social or occupational functioning and producing psychological or physiological dependency or both, evidenced by physical tolerance or withdrawal.

"Hospital" means a facility licensed as a hospital by the department of health and accredited by The Joint Commission.

"In-hospital services" means the provision of medical, nursing, or therapeutic services twenty-four hours a day in a hospital.

"Licensed clinical social worker" means a person who is a licensed clinical social worker pursuant to chapter 467E.

"Licensed dietitian" means a person who uses the title of licensed dietitian or dietitian and has been licensed to practice dietetics under chapter 448B.

"Licensed marriage and family therapist" means a person licensed in marriage and family therapy practice pursuant to chapter 451J.

"Licensed mental health counselor" means a person:

(1) Who engages in the practice of [mental] health counseling and uses the title of licensed mental health counselor;

(2) Who is licensed in mental health counseling practice pursuant to chapter 453D; and

(3) Whose license is in effect and not revoked or suspended.

"Mental health outpatient facility" means a mental health establishment, clinic, institution, center, or community mental health center that provides for the diagnosis, treatment, care, or rehabilitation of mentally ill persons and has been accredited by The Joint Commission or the Commission on Accreditation of Rehabilitation Facilities or certified by the department of health.

"Mental health outpatient services" means mental health nonresidential treatment provided on an ambulatory basis to patients with mental illness that includes interventions prescribed and performed by a physician, psychologist, licensed clinical social worker, licensed marriage and family therapist, licensed mental health counselor, or advanced practice registered nurse.

"Mental illness" means a syndrome of clinically significant psychological, biological, or behavioral abnormalities that results in personal distress or suffering, impairment of capacity for functioning, or both. For the purposes of this chapter, the terms "mental disorder" and "mental illness" shall be used interchangeably and shall include the definitions identified in the most recent publications of the Diagnostic and Statistical Manual of the American Psychiatric Association or International Classification of Disease. Epilepsy, senility, intellectual disability, or other developmental disabilities and addiction to or abuse of intoxicating substances do not in and of themselves constitute a mental disorder.

"Nonhospital facility" means a facility for the care or treatment of alcohol dependent, drug dependent, or mentally ill persons that has been accredited by The Joint Commission or the Commission on Accreditation of Rehabilitation Facilities or certified by the department of health and, if residential, has been licensed as a special treatment facility by the department of health.

"Nonhospital residential services" means the provision of medical, psychological, nursing, counseling, or therapeutic services to patients suffering from alcohol dependence, drug dependence, or mental illness by a nonhospital residential facility, according to individualized treatment plans.

"Partial hospitalization" means treatment services, including in-hospital treatment services or benefits, provided by a hospital or mental health outpatient facility to patients who, because of their conditions, require more than periodic hourly service. Partial hospitalization shall be prescribed by a physician or psychologist, and may be prescribed by a licensed clinical social worker, licensed marriage and family therapist, licensed mental health counselor, or advanced practice registered nurse in consultation with a physician or psychologist. Partial hospitalization requires less than twenty-four hours of care and a minimum of three hours in any one day.

"Physician" means a person licensed in the practice of medicine or osteopathy pursuant to chapter 453.

"Psychologist" means a person licensed in the practice of psychology pursuant to chapter 465.

"Qualified" means:

(1) Having skill in the diagnosis or treatment of substance use disorders, based on a practitioner's credentials, including but not limited to professional education, clinical training, licensure, board or other certification, clinical experience, letters of reference, other professional qualifications, and disciplinary action; or

(2) Being a licensed physician, psychologist, licensed clinical social worker, licensed marriage and family therapist, licensed mental health counselor, or advanced practice registered nurse, and certified pursuant to chapter 321.

"Substance abuse services" means the provision of medical, psychological, nursing, counseling, or therapeutic services in response to a treatment plan for alcohol or drug dependence or both which shall include, when appropriate, a combination of aftercare and individual, group, and family counseling services provided by qualified staff.

"Treatment episode" means one admission to an accredited hospital or nonhospital facility, or office of a qualified physician, psychologist, licensed clinical social worker, licensed marriage and family therapist, licensed mental health counselor, or advanced practice registered nurse for treatment of alcohol or drug dependence, or both, as stipulated in a prescribed treatment plan and that would generally produce remission in those who complete the treatment. The prescribed treatment plan may include the provision of substance abuse services in more than one location and may include in-hospital, nonhospital residential, day treatment, or alcohol or drug dependence outpatient services, or any combination thereof. An admission for only detoxification services shall not constitute a treatment episode. [L 1988, c 202, pt of §1, §3; am L 1991, c 90, §1; am L 1994, c 111, §§1, 4; am L 1997, c 247, §1 and c 273, §1; am L 1998, c 78, §3; am L 1999, c 36, §1, c 121, §§1, 6, and c 215, §1; am L 2000, c 243, §8(2); am L 2001, c 111, §§1, 2, 4; am L 2002, c 167, §3 and c 239, §1; am L 2003, c 197, §§2, 3; am L 2005, c 140, §1; am L 2006, c 205, §2; am L 2007, c 38, §1; am L 2008, c 206, §2; am L 2009, c 11, §52; am L 2011, c 220, §12; am L 2015, c 35, §47 and c 63, §25; am L 2016, c 29, §2 and c 141, §12; am L 2020, c 70, §57]
Haw. Rev. Stat. § 432G-10 — HI Code / Division 2 / Title 24 / Chapter 432G / Section 432G-10
Powers of insurers and hospital and medical service corporations.
Status: in_force

(a) An insurance company licensed in this State, or a hospital or medical service corporation authorized to do business in this State, either directly or through a subsidiary or affiliate, may organize and operate a dental insurer under the provisions of this chapter. Notwithstanding any other law to the contrary, any two or more insurance companies, hospital or medical service corporations, dental insurers, or subsidiaries or affiliates thereof, may jointly organize and operate a dental insurer. The business of insurance is deemed to include the providing of dental care services by a dental insurer owned or operated by an insurer or a subsidiary thereof.

(b) Notwithstanding any contrary provision of laws pertaining to insurance or hospital or medical service corporations under chapter 431, 432, or 432D, an insurer or a hospital or medical service corporation may contract with a dental insurer to provide insurance or similar protection against the cost of dental care services provided through dental insurers and to provide coverage in the event of the failure of the dental insurer to meet its obligations. The enrollees of a dental insurer constitute a group permitted under chapter 431, 432, or 432D. Among other things, under such contracts, the insurer or hospital or medical service corporation may make benefit payments to dental insurers for dental care services rendered by providers. [L 2013, c 191, pt of §1]
Haw. Rev. Stat. § 432D-23.5 — HI Code / Division 2 / Title 24 / Chapter 432D / Section 432D-23.5
Coverage for telehealth.
Status: in_force

(a) [Repeal and reenactment on December 31, 2027. L 2025, c 217, §1.] It is the intent of the legislature to recognize the application of telehealth as a reimbursable service by which an individual shall receive medical services from a health care provider without in-person contact with the health care provider.

(b) [Repeal and reenactment on December 31, 2027. L 2025, c 217, §1.] No health maintenance organization plan that is issued, amended, or renewed shall require in-person contact between a health care provider and a patient as a prerequisite for payment for services appropriately provided through telehealth in accordance with generally accepted health care practices and standards prevailing in the applicable professional community at the time the services were provided. The coverage required in this section may be subject to all terms and conditions of the plan agreed upon among the enrollee or subscriber, the health maintenance organization, and the health care provider.

(c) [Repeal and reenactment on December 31, 2027. L 2025, c 217, §1.] Reimbursement for services provided through telehealth via an interactive telecommunications system shall be equivalent to reimbursement for the same services provided via in-person contact between a health care provider and a patient; provided that reimbursement for two-way, real-time audio-only communication technology for purposes of diagnosis, evaluation, or treatment of a mental health disorder to a patient in the patient's home shall be equivalent to eighty per cent of the reimbursement for the same services provided via in-person contact between a health care provider and a patient. To be reimbursed for telehealth via an interactive telecommunications system using two-way, real-time audio-only communication technology in accordance with this subsection, the health care provider shall first conduct an in-person visit or a telehealth visit that is not audio only, within six months prior to the initial audio-only visit, or within twelve months prior to any subsequent audio-only visit. The telehealth visit required prior to the initial or subsequent audio-only visit in this subsection shall not be provided using audio-only communication. Nothing in this section shall require a health care provider to be physically present with the patient at an originating site unless a health care provider at the distant site deems it necessary.

(d) Notwithstanding chapter 453 or rules adopted pursuant thereto, in the event that a health care provider-patient relationship does not exist between the patient and the health care provider involved in a telehealth interaction between the patient and the health care provider, a telehealth mechanism may be used to establish a health care provider-patient relationship.

(e) All health maintenance organizations shall provide current and prospective insureds with written disclosure of coverages and benefits associated with telehealth services, including information on copayments, deductibles, or coinsurance requirements under a policy, contract, plan, or agreement. The information provided shall be current, understandable, and available prior to enrollment in a policy, contract, plan, or agreement and upon request after enrollment in the policy, contract, plan, or agreement.

(f) Services provided by telehealth pursuant to this section shall be consistent with all federal and state privacy, security, and confidentiality laws.

(g) [Repeal and reenactment on December 31, 2027. L 2025, c 217, §1.] For the purposes of this section:

"Distant site" means the location of the health care provider delivering services through telehealth at the time the services are provided.

"Health care provider" means a provider of services, as defined in title 42 United States Code section 1395x(u), a provider of medical and other health services, as defined in title 42 United States Code section 1395x(s), other practitioners licensed by the State and working within their scope of practice, and any other person or organization who furnishes, bills, or is paid for health care in the normal course of business, including but not limited to primary care providers, mental health providers, oral health providers, physicians and osteopathic physicians licensed under chapter 453, advanced practice registered nurses licensed under chapter 457, psychologists licensed under chapter 465, and dentists licensed under chapter 448.

"Interactive telecommunications system" has the same meaning as the term is defined in title 42 Code of Federal Regulations section 410.78(a).

"Originating site" means the location where the patient is located, whether accompanied or not by a health care provider, at the time services are provided by a health care provider through telehealth, including but not limited to a health care provider's office, hospital, health care facility, a patient's home, and other nonmedical environments such as school-based health centers, university-based health centers, or the work location of a patient.

"Telehealth" means the use of telecommunications services, as defined in section 269-1, to encompass four modalities: store and forward technologies, remote monitoring, live consultation, and mobile health; and which shall include but not be limited to real-time video conferencing-based communication, secure interactive and non-interactive web-based communication, and secure asynchronous information exchange, to transmit patient medical information, including diagnostic-quality digital images and laboratory results for medical interpretation and diagnosis, for the purpose of delivering enhanced health care services and information while a patient is at an originating site and the health care provider is at a distant site. Except as provided through an interactive telecommunications system, standard telephone contacts, facsimile transmissions, or e-mail text, in combination or alone, do not constitute telehealth services. [L 1998, c 278, §4; am L 2006, c 219, §4; am L 2009, c 20, §5; am L 2014, c 159, §5; am L 2016, c 226, §8 ; am L 2023, c 107, §§5, 8 ]
Haw. Rev. Stat. § 431P-12 — HI Code / Division 2 / Title 24 / Chapter 431P / Section 431P-12
Mitigation.
Status: in_force

The fund shall develop a comprehensive loss reduction plan for the hurricane peril. The plan shall include standards for new residential and commercial structures and separate standards for existing residential and commercial structures. The plan shall provide a timetable for implementation of mandatory loss mitigation measures for both new and existing structures.
Haw. Rev. Stat. § 431C-49 — HI Code / Division 2 / Title 24 / Chapter 431C / Section 431C-49
Injunctions; civil remedies; cease and desist.
Status: in_force

(a) In addition to the penalties and other enforcement provisions of this chapter, if any person violates this chapter or any rule implementing this chapter, the commissioner may seek an injunction in a court of competent jurisdiction in the county in which the person resides or has a principal place of business and may apply for temporary and permanent orders that the commissioner determines necessary to restrain the person from further committing the violation.

(b) Any person damaged by the acts of another person in violation of this chapter or any rule implementing this chapter, may bring a civil action for damages against the person committing the violation in a court of competent jurisdiction.

(c) The commissioner may issue a cease and desist order upon a person who violates any provision of this chapter, any rule or order adopted by the commissioner, or any written agreement entered into with the commissioner, in accordance with chapter 91.

(d) When the commissioner finds that such an action presents an immediate danger to the public and requires an immediate final order, the commissioner may issue an emergency cease and desist order reciting with particularity the facts underlying such findings. The emergency cease and desist order shall be effective immediately upon service of a copy of the order on the respondent and shall remain effective for ninety days. If the commissioner begins non-emergency cease and desist proceedings under subsection (a), the emergency cease and desist order shall remain effective, absent an order by an appellate court of competent jurisdiction pursuant to chapter 91. In the event of a wilful violation of this chapter, the trial court may award statutory damages in addition to actual damages in an additional amount up to three times the actual damage award. The provisions of this chapter may not be waived by agreement. No choice of law provision may be used to prevent the application of this chapter to any life settlement contract in which a party to the settlement is a resident of this State. [L 2012, c 256, pt of §1]
Haw. Rev. Stat. § 432G-5 — HI Code / Division 2 / Title 24 / Chapter 432G / Section 432G-5
Information to subscribers.
Status: in_force

(a) The dental insurer shall provide to its subscribers a list of providers and participating providers, upon enrollment and reenrollment.

(b) Every dental insurer shall provide to its subscribers notice of any material change in the operation of the organization that will affect them directly within thirty days of the material change.

(c) The dental insurer shall provide to subscribers information on how dental care services may be obtained, where additional information on access to dental care services may be obtained, a description of the internal grievance procedures, and a telephone number for a subscriber to contact the dental insurer at no cost to the subscriber.

(d) For the purpose of this section, "material change" means any major change in provider or participating provider agreements. [L 2013, c 191, pt of §1]
Haw. Rev. Stat. § 431N-7 — HI Code / Division 2 / Title 24 / Chapter 431N / Section 431N-7
Violation, penalty.
Status: in_force

Any person who violates this chapter or any rule adopted by the department of health pursuant to this chapter may be permanently disqualified from participation in the program, required to reimburse any benefits wrongfully obtained, and shall be fined not more than $500. Any action taken to impose or collect the penalty provided for in this section may be considered a civil action.
Haw. Rev. Stat. § 432G-14 — HI Code / Division 2 / Title 24 / Chapter 432G / Section 432G-14
Summary orders and supervision.
Status: in_force

(a) Whenever the commissioner determines that the financial condition of any dental insurer is such that its continued operation might be hazardous to its enrollees, creditors, or the general public, or that it has violated any provision of this chapter, the commissioner, after notice and hearing, may order the dental insurer to take such action as may be reasonably necessary to rectify such condition or violation, including but not limited to:

(1) Reducing the total amount of present and potential liability for benefits by reinsurance or other method acceptable to the commissioner;

(2) Reducing the volume of new business being accepted;

(3) Reducing expenses by specified methods;

(4) Suspending or limiting the writing of new business for a period of time;

(5) Increasing the dental insurer's capital and surplus by contribution; or

(6) Taking any other steps as the commissioner may deem appropriate under the circumstances.

(b) For purposes of this section, the violation by a dental insurer of any law of this State to which the dental insurer is subject shall be deemed a violation of this chapter.

(c) The commissioner is authorized to set uniform standards and criteria for early warning that the continued operation of any dental insurer might be hazardous to its enrollees, creditors, or the general public, and to set standards for evaluating the financial condition of any dental insurer, which standards shall be consistent with the purposes expressed in subsection (a).

(d) The remedies and measures available to the commissioner under this section shall be in addition to, and not in lieu of, the remedies and measures available to the commissioner under the provisions of article 15 of chapter 431. [L 2013, c 191, pt of §1]
Haw. Rev. Stat. § 431K-12 — HI Code / Division 2 / Title 24 / Chapter 431K / Section 431K-12
Binding effect of orders issued in United States District Court.
Status: in_force

An order issued by any district court of the United States enjoining a risk retention group from soliciting or selling insurance, or operating in any state or in all states or in any territory or possession of the United States upon a finding that the group is in a hazardous financial condition shall be enforceable in the courts of this State.
Haw. Rev. Stat. § 432C-5 — HI Code / Division 2 / Title 24 / Chapter 432C / Section 432C-5
Transfer of assets to other nonprofit entities.
Status: in_force

The commissioner shall determine prior to any conversion, the nonprofit entities, if any, that are eligible to receive assets from the converting nonprofit entity. The charitable mission and grant-making functions of each eligible nonprofit entity must:

(1) Be dedicated to promoting or serving the health care needs of residents of the State;

(2) Not be in direct competition with the converting nonprofit entity; and

(3) Be in existence and have qualified for tax-exempt status under Title 26 United States Code section 501(c)(3), (4), (8), (9), (26), or (e), before the transfer of assets. [L 1998, c 260, pt of §2]
Haw. Rev. Stat. § 432G-20 — HI Code / Division 2 / Title 24 / Chapter 432G / Section 432G-20
Disclosure of dental care coverage and benefits.
Status: in_force

In order to ensure that all individuals understand their dental care options and are able to make informed decisions, all dental insurers shall provide current and prospective subscribers with written disclosure of coverages and benefits, including information on coverage principles and any exclusions or restrictions on coverage.

The information provided shall be current, understandable, and available prior to enrollment, and upon request after enrollment. A policy or contract provided to a subscriber which describes coverages and benefits shall be in conformance with part I of article 10 of chapter 431. [L 2013, c 191, pt of §1]
Haw. Rev. Stat. § 431C-13 — HI Code / Division 2 / Title 24 / Chapter 431C / Section 431C-13
Examination reports.
Status: in_force

(a) Examination reports shall be comprised of only facts appearing upon the books, from the testimony of its officers, directors, employees, or agents or other persons examined concerning its affairs, and such conclusions and recommendations as the examiners find reasonably warranted from the facts.

(b) No later than sixty days following completion of the examination, the examiner in charge shall file with the commissioner a verified written report of examination under oath. Upon receipt of the verified report, the commissioner shall transmit the report to the licensee examined, together with a notice that shall afford the licensee examined a reasonable opportunity of not more than thirty days to make a written submission or rebuttal with respect to any matters contained in the examination report and which shall become part of the report or to request a hearing on any matter in dispute.

(c) In the event the commissioner determines that regulatory action is appropriate as a result of an examination, the commissioner may initiate any proceedings or actions provided by law. [L 2012, c 256, pt of §1]
Haw. Rev. Stat. § 432G-11 — HI Code / Division 2 / Title 24 / Chapter 432G / Section 432G-11
Examinations.
Status: in_force

(a) The commissioner may examine the affairs of any dental insurer or of any providers with whom a dental insurer has contracts, agreements, or other arrangements as often as is reasonably necessary for the protection of the interests of the people of this State.

(b) Every dental insurer and provider shall submit its books and records for examination and in every way facilitate the completion of an examination by the commissioner. In the event a dental insurer or a provider fails to comply with the directions of the commissioner, the commissioner may examine the affiliates of the dental insurer or provider to obtain the information. For the purpose of examinations, the commissioner may administer oaths to and examine the officers and agents of the dental insurer and the principals of providers concerning their business.

(c) The cost of examinations under this section shall be assessed against the dental insurer or provider being examined and shall be remitted to the commissioner for deposit into the compliance resolution fund.

(d) In lieu of the commissioner's own examination, the commissioner may accept the report of an examination made by the commissioner or the appropriate official of another state. [L 2013, c 191, pt of §1]
Haw. Rev. Stat. § 431C-14 — HI Code / Division 2 / Title 24 / Chapter 431C / Section 431C-14
Confidentiality of examination information.
Status: in_force

(a) Names and individual identification data for all owners, purchasers, and insureds shall be considered private and confidential information and shall not be disclosed by the commissioner, unless the disclosure is to another regulator or is required by law.

(b) Except as otherwise provided in this chapter, all examination reports, working papers, recorded information, documents and copies thereof produced by, obtained by, or disclosed to the commissioner or any other person in the course of an examination made under this chapter, or in the course of analysis or investigation by the commissioner of the financial condition or market conduct of a licensee, shall be confidential by law and privileged, shall not be subject to chapter 92F, shall not be subject to subpoena, and shall not be subject to discovery or admissible in evidence in any private civil action. The commissioner is authorized to use the documents, materials, or other information in the furtherance of any regulatory or legal action brought as part of the commissioner's official duties. The licensee being examined may have access to all documents used to make the report. [L 2012, c 256, pt of §1]
Haw. Rev. Stat. § 432G-21 — HI Code / Division 2 / Title 24 / Chapter 432G / Section 432G-21
Federal law compliance.
Status: in_force

All dental insurers shall comply with applicable federal law. The commissioner shall enforce the consumer protections and market reforms relating to insurance as set forth in the federal Patient Protection and Affordable Care Act, Public Law 111-148.
Haw. Rev. Stat. § 435C-4 — HI Code / Division 2 / Title 24 / Chapter 435C / Section 435C-4
Procedures.
Status: in_force

§435C-4 Procedures.

(a)(1) Any licensed physician or hospital shall, on or after the effective date of the plan of operation, apply to the plan for such coverage. Such application may be made on behalf of an applicant by a producer authorized by the applicant.

(2) If the plan determines that the applicant meets the underwriting standards of the plan as provided in the plan of operation and there is no unpaid, uncontested premium due from the applicant for prior insurance (as shown by the insured having failed to make written objection to the premium charges within thirty days after billing), then the plan, upon receipt of the premium, or such portion thereof as is prescribed in the plan of operation, shall cause to be issued a policy of medical malpractice insurance for a term of one year.

(b)(1) The rates, rating plan, rating classifications, territory, and policy forms applicable to the insurance written by the plan and statistics relating thereto shall be subject to sections 431:14-101 to 431:14-117 unless otherwise provided hereto, giving due consideration to the past and prospective loss and expense experience within and outside this State for medical malpractice insurance of all of the member companies of the plan, trends in the frequency and severity of losses, the investment income of the plan, and such other information as the insurance commissioner may require;

(2) Any deficit sustained by the plan in any one year shall be recouped, pursuant to the plan of operation and the rating plan then in effect by one or both of the following procedures:

(A) An assessment upon the policyholders; or

(B) A rate increase applicable prospectively;

(3) Effective after the initial year of operation, rating plans and rating rules, and any provisions of recoupment through policyholder assessment or premium rate increase, shall be based upon the plan's loss and expense experience, together with such other information based upon such experience as the insurance commissioner may deem appropriate. The resultant premium rates shall be on an actuarially sound basis and shall be calculated to be self-supporting;

(4) In the event that sufficient funds are not available for the sound financial operation of the plan, pending recoupment as provided in paragraph (3) of this subsection, all members shall, on a temporary basis contribute to the financial requirements of the plan in the manner provided for in section 435C-5. Any such contribution shall be reimbursed to the members following recoupment as provided in paragraph (3) of this subsection; and

(5) The commissioner shall consider requiring the plan to offer policies on a claims made or occurrence basis; provided that the premium rate charged for the policies shall be at rates established on an actuarially sound basis and that are calculated to be self-supporting. [L 1975, c 161, pt of §1; am L 1998, c 204, §2; am L 2002, c 155, §105; am L 2004, c 122, §94]
Haw. Rev. Stat. § 431K-11 — HI Code / Division 2 / Title 24 / Chapter 431K / Section 431K-11
Duty of producer to obtain license and to keep records.
Status: in_force

(a) Any person acting or offering to act as a producer for a risk retention group or purchasing group which solicits members, sells insurance coverage, purchases coverage for its members located within the State, or otherwise does business in this State, before commencing any such activity shall obtain a license from the commissioner.

(b) Whenever a licensed insurance producer or surplus lines producer places business pursuant to subsection (a), the producer shall keep a complete and separate record of each policy procured from a risk retention group and for a purchasing group. The record shall be open to examination by the commissioner. For each policy and each kind of insurance provided in the policy, the record shall include the following:

(1) The limit of liability and peril insured;

(2) A brief description of the property insured and its location;

(3) The effective date of the contract and its terms;

(4) The time period covered by the contract;

(5) The gross premium charged;

(6) Any return premiums paid;

(7) The name and address of the risk retention group which issued the policy;

(8) The name and address of the insured; and

(9) Any additional information required by the commissioner. [L 1987, c 180, pt of §1; am L 1989, c 272, §8; am L 2001, c 216, §26]
Haw. Rev. Stat. § 432E-42 — HI Code / Division 2 / Title 24 / Chapter 432E / Section 432E-42
[ §432E-42] Funding of external review.
Status: in_force

[ §432E-42] Funding of external review. The health carrier against which a request for a standard external review or an expedited external review is filed shall pay the cost of the independent review organization for conducting the external review. There shall be no recourse against the commissioner for the cost of conducting the external review and the selection of an independent review organization shall not be subject to chapter 103D; provided that the commissioner may initially approve up to three independent review organizations to serve beginning on the effective date of this part until the initial procurement process is completed; provided further that in any year in which procurement subject to chapter 103D does not produce at least three independent review organizations eligible for selection under section 432E-39, the commissioner may approve up to three independent review organizations notwithstanding the requirements of chapter 103D.
Haw. Rev. Stat. § 432E-32 — HI Code / Division 2 / Title 24 / Chapter 432E / Section 432E-32
[ §432E-32] Notice of right to external review.
Status: in_force

[ §432E-32] Notice of right to external review. Notice of the right to external review issued pursuant to this part shall set forth the options available to the enrollee under this part. The commissioner may specify the form and content of notice of external review.
Haw. Rev. Stat. § 432D-23.6 — HI Code / Division 2 / Title 24 / Chapter 432D / Section 432D-23.6
Federally funded programs; exemption.
Status: in_force

Requirements relating to mandated coverages shall not be applicable to any health maintenance organization offering health insurance under a federally funded program under the Social Security Act, as amended; provided that this exemption shall apply only to that part of the health maintenance organization's business under the federally funded program.
Haw. Rev. Stat. § 435E-33 — HI Code / Division 2 / Title 24 / Chapter 435E / Section 435E-33
Compensation.
Status: in_force

No person shall receive, or be entitled to receive any payment, bonus, salary, income, compensation, or other benefit whatsoever, either from the reserve trust fund or the income therefrom or from any other funds of the interindemnity arrangement or the members thereof based on the number of participating members, or the amount of the reserve trust fund or other funds of the interindemnity arrangement.
Haw. Rev. Stat. § 431R-6 — HI Code / Division 2 / Title 24 / Chapter 431R / Section 431R-6
Application.
Status: in_force

If this chapter or any provision of this chapter conflicts at any time with any federal law, then the federal law shall prevail and this chapter or the relevant provisions of this chapter shall become ineffective and invalid. The ineffectiveness or invalidity of this chapter or any of its provisions shall not affect any other provisions or applications of this chapter, which shall be given effect without the invalid provision or application, and to this end, the provisions of this chapter are severable.
Haw. Rev. Stat. § 435E-24 — HI Code / Division 2 / Title 24 / Chapter 435E / Section 435E-24
Noncomplying member.
Status: in_force

In the event a participating member fails to comply with any provision of the trust agreement (other than a failure to pay assessments when due), the board of trustees may terminate the person's membership status if such failure to comply is not cured within sixty days from the date the person is notified of the failure; provided that before such membership status may be terminated such person shall be given the right to call for a hearing before the board of trustees (to be held before the expiration of such sixty-day period), at which hearing such person shall be given the opportunity to demonstrate to the board of trustees that no failure to comply has occurred; or, if it has occurred, that it has been cured. Upon termination, the former participating member shall not be entitled to the return of all or any part of his or her initial contribution, and the indemnity coverage shall thereupon terminate as to all claims then pending against such person and in respect to all occurrences prior to the date of such termination of membership. However, in the event the interindemnity arrangement is then providing legal defense services to such person, the interindemnity arrangement shall continue to provide those services for a period of ten days following such termination.
Haw. Rev. Stat. § 431C-33 — HI Code / Division 2 / Title 24 / Chapter 431C / Section 431C-33
General rules.
Status: in_force

(a) A provider entering into a life settlement contract with any owner of a policy, wherein the insured is terminally or chronically ill, shall first obtain:

(1) If the owner is the insured, a written statement from a licensed attending physician that the owner is of sound mind and under no constraint or undue influence to enter into a life settlement contract; and

(2) A document in which the insured consents to the release of the insured's medical records to a provider, broker, or insurance producer and, if the policy was issued less than two years from the date of application for a life settlement contract, to the insurance company that issued the policy.

The provider, broker, or its authorized representative shall be limited to contact for the purpose of determining the owner's health status or to verify the owner's address, once every three months if the insured has a life expectancy of more than one year, and no more than once per month if the insured has a life expectancy of one year or less.

(b) The insurer shall respond to a request for verification of coverage submitted by a provider, broker, or life insurance producer, not later than thirty calendar days of the date the request is received. The request for verification of coverage shall be made on a form approved by the commissioner. The insurer shall complete and issue the verification of coverage or indicate in which respects it is unable to respond. In its response, the insurer shall indicate whether, based on the medical evidence and documents provided, the insurer intends to pursue an investigation at this time regarding the validity of the insurance contract.

(c) Before or at the time of execution of the life settlement contract, the provider shall obtain a witnessed document in which the owner:

(1) Consents to the life settlement contract;

(2) Represents that the owner has a full and complete understanding of the life settlement contract;

(3) Represents that the owner has a full and complete understanding of the benefits of the policy;

(4) Acknowledges that the owner is entering into the life settlement contract freely and voluntarily; and

(5) For persons with a chronic or terminal illness or condition, acknowledges that the insured has a chronic or terminal illness and that the chronic or terminal illness or condition was diagnosed after the policy was issued.

(d) An insurer shall not unreasonably delay effecting change of ownership or beneficiary in connection with any life settlement contract lawfully entered into in this State or with a resident of this State.

(e) If a broker or life insurance producer performs any of the activities required of the provider under this section, the provider shall be deemed to have fulfilled the requirements of this section.

(f) If a broker performs those verification of coverage activities required of the provider, the provider is deemed to have performed those activities.

(g) Within twenty days after an owner executes the life settlement contract, the provider shall give written notice to the insurer that issued that policy that the policy has become subject to a life settlement contract. The notice shall be accompanied by the documents required by section 431C-32(c).

(h) All life settlement contracts entered into in this State shall provide that the owner may rescind the contract on or before fifteen days after the date it is executed by all parties thereto. Rescission, if exercised by the owner, is effective only if both notice of the rescission is given, and the owner repays all proceeds and any premiums, loans, and loan interest paid on account of the provider within the rescission period. If the insured dies during the rescission period, the contract shall be deemed to have been rescinded subject to repayment by the owner or the owner's estate of all proceeds and any premiums, loans, and loan interest to the provider.

(i) Within three business days after receipt from the owner of documents to effect the transfer of the policy, the provider shall pay the proceeds of the settlement to an escrow or trust account managed by a trustee or escrow agent in a state or federally chartered financial institution pending acknowledgment of the transfer by the issuer of the policy. The trustee or escrow agent shall be required to transfer the proceeds due to the owner within three business days of acknowledgment of the transfer from the insurer.

(j) Failure to tender the life settlement contract proceeds to the owner by the date disclosed to the owner shall render the contract voidable by the owner for lack of consideration until the time the proceeds are tendered to and accepted by the owner. A failure to give written notice of the right of rescission hereunder shall toll the right of rescission until thirty days after the written notice of the right of rescission has been given.

(k) Any fee paid by a provider, party, individual, or an owner to a broker in exchange for services provided to the owner pertaining to a life settlement contract shall be computed as a percentage of the offer obtained, not the face value of the policy. Nothing in this section shall be construed as prohibiting a broker from reducing such broker's fee below this percentage if the broker so chooses.

(l) The broker shall disclose to the owner anything of value paid or given to a broker and that relates to a life settlement contract.

(m) No person at any time prior to or at the time of the application for, or issuance of, a policy, or during a two-year period commencing with the date of issuance of the policy, shall enter into a life settlement contract regardless of the date the compensation is to be provided and regardless of the date the assignment, transfer, sale, devise, bequest, or surrender of the policy is to occur. This prohibition shall not apply if the owner certifies to the provider that:

(1) The policy was issued upon the owner's exercise of conversion rights arising out of a group or individual policy; provided that the total of the time covered under the conversion policy plus the time covered under the prior policy is at least two years. The time covered under a group policy shall be calculated without regard to a change in insurance carriers; provided further that the coverage has been continuous and under the same group sponsorship; or

(2) The owner submits independent evidence to the provider that one or more of the following conditions have been met within the two-year period:

(A) The owner or insured is chronically or terminally ill;

(B) The owner or insured disposes of ownership interests in a closely-held corporation, pursuant to the terms of a buyout or other similar agreement in effect at the time the policy was initially issued;

(C) The owner's spouse dies;

(D) The owner divorces the owner's spouse;

(E) The owner retires from full-time employment;

(F) The owner becomes physically or mentally disabled and a physician determines that the disability prevents the owner from maintaining full-time employment; or

(G) A final order, judgment, or decree is entered by a court of competent jurisdiction, on the application of a creditor of the owner, adjudicating the owner bankrupt or insolvent, or approving a petition seeking reorganization of the owner or appointing a receiver, trustee, or liquidator to all or a substantial part of the owner's assets.

Copies of the independent evidence required by paragraph (2) shall be submitted to the insurer when the provider submits a request to the insurer for verification of coverage. The copies shall be accompanied by a letter of attestation from the provider that the copies are true and correct copies of the documents received by the provider. Nothing in this section shall prohibit an insurer from exercising its right to contest the validity of any policy.

If the provider submits to the insurer a copy of independent evidence required by paragraph (2) when the provider submits a request to the insurer to effect the transfer of the policy to the provider, the copy shall be deemed to establish that the life settlement contract satisfies the requirements of this section. [L 2012, c 256, pt of §1]
Haw. Rev. Stat. § 431K-7.5 — HI Code / Division 2 / Title 24 / Chapter 431K / Section 431K-7.5
Purchasing group taxation.
Status: in_force

Premium taxes and taxes on premiums paid for coverage of risks resident or located in this State by a purchasing group or any members of the purchasing group shall be:

(1) Imposed at the same rate and subject to the same interest, fines, and penalties as that applicable to premium taxes and taxes on premiums paid for similar coverage from a similar insurance source by other insurers; and

(2) Paid first by that insurance source, and if not by that source, then by the producer for the purchasing group, and if not by that producer, then by the purchasing group, and if not by that purchasing group, then by each of its members. [L 1993, c 321, §4; am L 2002, c 155, §99]
Haw. Rev. Stat. § 431L-3 — HI Code / Division 2 / Title 24 / Chapter 431L / Section 431L-3
Coverage of children.
Status: in_force

(a) No insurer shall deny enrollment of a child under the health plan of the child's parent for the following grounds:

(1) The child was born out of wedlock;

(2) The child is not claimed as a dependent on the parent's federal tax return; or

(3) The child does not reside with the parent or in the insurer's service area.

(b) Where a child has health coverage through an insurer of a noncustodial parent the insurer shall:

(1) Provide such information to the custodial parent as may be necessary for the child to obtain benefits through that coverage;

(2) Permit the custodial parent (or the provider, with the custodial parent's approval) to submit claims for covered services without the approval of the noncustodial parent; and

(3) Make payments on claims submitted in accordance with paragraph (2) directly to the custodial parent, the provider, or the state medicaid agency.

(c) Where a parent is required by a court or administrative order to provide health coverage for a child, and the parent is eligible for family coverage, as defined in section 431:10A-103, and reciprocal beneficiary family coverage, as defined in section 431:10A-601, the insurer shall be required:

(1) To permit the parent to enroll, under the family coverage or reciprocal beneficiary family coverage, a child who is otherwise eligible for the coverage without regard to any enrollment season restrictions;

(2) If the parent is enrolled but fails to make application to obtain coverage for the child, to enroll the child under family coverage or reciprocal beneficiary family coverage upon application of the child's other parent, the state agency administering the medicaid program, or the state agency administering the child support enforcement program; and

(3) Not to disenroll (or eliminate coverage of) the child unless the insurer is provided satisfactory written evidence that:

(A) The court or administrative order is no longer in effect; or

(B) The child is or will be enrolled in comparable health coverage through another insurer that will take effect not later than the effective date of disenrollment.

(d) An insurer may not impose requirements on a state agency, which has been assigned the rights of an individual eligible for medical assistance under medicaid and covered for health benefits from the insurer, that are different from requirements applicable to an agent or assignee of any other individual so covered. [L 1995, c 83, pt of §2; am L 1997, c 383, §8; am L 2004, c 122, §81]
Haw. Rev. Stat. § 432G-12 — HI Code / Division 2 / Title 24 / Chapter 432G / Section 432G-12
Fees.
Status: in_force

(a) The commissioner shall collect, in advance, the following fees:

(1) Certificate of authority:

(A) Application for a certificate of authority: $900; and

(B) Issuance of certificate of authority: $600; and

(2) For all services subsequent to the issuance of a certificate of authority, including extension of the certificate of authority: $600 per year.

The commissioner may, upon showing of good cause, waive or modify, in whole or part, all fees in this subsection by order.

(b) No certificate of authority shall contain an expiration date, but all certificates of authority shall be extended by the commissioner from time to time in order to continue to be valid. When the commissioner issues or extends a certificate of authority, the commissioner shall determine the date prior to which the certificate of authority shall be extended and shall so notify the insurer in writing. This date is called the extension date. The extension date shall be any date not less than one year and not more than three years after date of issue or extension of the certificate of authority. If the insurer qualifies, its certificate of authority shall be extended. The commissioner shall provide each holder of a certificate of authority at least thirty days' advance written notice of the applicable extension date. If the fee for the extension of the certificate of authority is not paid before or on the extension date, a penalty shall be imposed in the amount of fifty per cent of the fee. The commissioner shall provide notice in writing of the delinquency of extension and the imposition of the authorized penalty. If the fee and the penalty are not paid within thirty days immediately following the date of the notice of delinquency, the commissioner may revoke the certificate of authority and may not reinstate the certificate of authority until the fee and penalty have been paid.

(c) All fees and penalties collected pursuant to this section shall be deposited into the compliance resolution fund. [L 2013, c 191, pt of §1; am L 2015, c 63, §§20, 21; am L 2021, c 110, §22]
Haw. Rev. Stat. § 431C-45 — HI Code / Division 2 / Title 24 / Chapter 431C / Section 431C-45
Immunity from liability.
Status: in_force

(a) No civil liability shall be imposed on and no cause of action shall arise from a person's furnishing information concerning suspected, anticipated, or completed fraudulent life settlement acts or suspected or completed fraudulent insurance acts, if the information is provided to or received from:

(1) The commissioner or the commissioner's employees, agents, or representatives;

(2) Federal, state, or local law enforcement or regulatory officials or their employees, agents, or representatives;

(3) A person involved in the prevention and detection of fraudulent life settlement acts or that person's agents, employees, or representatives;

(4) Any regulatory body or their employees, agents, or representatives, overseeing life insurance, life settlements, securities, or investment fraud;

(5) The life insurer that issued the policy covering the life of the insured; or

(6) The licensee and any agents, employees, or representatives.

(b) Subsection (a) shall not apply to statements made with actual malice. In an action brought against a person for filing a report or furnishing other information concerning a fraudulent life settlement act or a fraudulent insurance act, the party bringing the action shall plead specifically any allegation that subsection (a) does not apply because the person filing the report or furnishing the information did so with actual malice.

(c) A person identified in subsection (a) shall be entitled to an award of attorney's fees and costs if the person is the prevailing party in a civil cause of action for libel, slander, or any other relevant tort arising out of activities in carrying out the provisions of this chapter and the party bringing the action was not substantially justified in doing so. For purposes of this section, a proceeding is "substantially justified" if it had a reasonable basis in law or fact at the time that it was initiated.

(d) This section does not abrogate or modify common law or statutory privileges or immunities enjoyed by a person identified in subsection (a). [L 2012, c 256, pt of §1]
Haw. Rev. Stat. § 432E-5 — HI Code / Division 2 / Title 24 / Chapter 432E / Section 432E-5
Complaints and appeals procedure for enrollees.
Status: in_force

(a) A health carrier with enrollees in this State shall establish and maintain a procedure to provide for the resolution of an enrollee's complaints and internal appeals. The procedure shall provide for expedited internal appeals under section 432E-6.5. The definition of medical necessity in section 432E-1.4 shall apply in a health carrier's complaints and internal appeals procedures.

(b) The health carrier shall at all times make available its complaints and internal appeals procedures. The complaints and internal appeals procedures shall be reasonably understandable to the average layperson and shall be provided in a language other than English upon request.

(c) A health carrier shall decide any expedited internal appeal as soon as possible after receipt of the complaint, taking into account the medical exigencies of the case, but not later than seventy-two hours after receipt of the request for expedited appeal.

(d) A health carrier shall send notice of its final internal determination within sixty days of the submission of the complaint to the enrollee, the enrollee's appointed representative, if applicable, the enrollee's treating provider, and the commissioner. The notice shall include the following information regarding the enrollee's rights and procedures:

(1) The enrollee's right to request an external review;

(2) The one hundred thirty day deadline for requesting an external review;

(3) Instructions on how to request an external review; and

(4) Where to submit the request for an external review.

In addition to these general requirements, the notice shall conform to the requirements of sections 432E-35 and 432E-36. [L 1998, c 178, pt of §2; am L 1999, c 137, §5; am L 2000, c 250, §4; am L 2004, c 27, §1; am L 2011, c 230, §7; am L 2012, c 34, §11]
Haw. Rev. Stat. § 432D-29 — HI Code / Division 2 / Title 24 / Chapter 432D / Section 432D-29
Prohibition on rescissions of coverage.
Status: in_force

(a) Notwithstanding sections 431:10-226.5 and 431:10A-106 to the contrary, a health maintenance organization shall not rescind coverage under a health benefit plan with respect to an individual, including a group to which the individual belongs or family coverage in which the individual is included, after the individual is covered under the plan, unless:

(1) The individual or a person seeking coverage on behalf of the individual performs an act, practice, or omission that constitutes fraud;

(2) The individual makes an intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage; or

(3) The individual fails to timely pay required premiums or contributions toward the cost of coverage; provided that the rescission is in compliance with federal regulations.

As used in this subsection, "a person seeking coverage on behalf of the individual" shall not include an insurance producer or employee or authorized representative of the health carrier.

(b) A health maintenance organization shall provide at least thirty days advance written notice to each plan enrollee or, for individual health insurance coverage, to each primary subscriber, who would be affected by the proposed rescission of coverage before coverage under the plan may be rescinded in accordance with subsection (a) regardless of whether, in the case of group health insurance coverage, the rescission applies to the entire group or only to an individual within the group.

(c) This section applies regardless of any applicable contestability period. [L 2014, c 186, §3]
Haw. Rev. Stat. § 432G-3 — HI Code / Division 2 / Title 24 / Chapter 432G / Section 432G-3
Fiduciary responsibilities.
Status: in_force

(a) Any director, officer, employee, or partner of a dental insurer who receives, collects, disburses, or invests funds in connection with the activities of an organization shall be responsible for the funds in a fiduciary relationship to the organization.

(b) A dental insurer shall maintain in force a fidelity bond or fidelity insurance on employees, officers, directors, and partners subject to subsection (a) in an amount not less than $250,000 for each dental insurer or a maximum of $5,000,000 in aggregate maintained on behalf of dental insurers owned by a common parent corporation, or a sum as may be prescribed by the commissioner. [L 2013, c 191, pt of §1]
Haw. Rev. Stat. § 435E-22 — HI Code / Division 2 / Title 24 / Chapter 435E / Section 435E-22
Disability of member.
Status: in_force

During any period in which a participating member, who is then in full compliance with the trust agreement, has, in the judgment of the board of trustees, become unable to perform any and every duty of his or her regular professional occupation, the indemnity coverage shall continue for the benefit of such member and such member shall not be responsible for assessments levied during such period.
Haw. Rev. Stat. § 435C-2 — HI Code / Division 2 / Title 24 / Chapter 435C / Section 435C-2
Definitions.
Status: in_force

As used in this chapter:

"Medical malpractice insurance" means insurance coverage against the legal liability of the insured and against loss, damage, or expense incident to a claim arising out of the death or injury of any person as the result of negligence or malpractice in rendering professional service by any licensed physician or hospital.

"Net direct premiums" means general casualty insurance direct premiums written as reported on the Hawaii State Page of the Exhibit of Premium and Losses of the annual statement under medical malpractice, workers' compensation, and other liability lines of business.

"Plan" means the joint underwriting plan established pursuant to the provisions of this chapter. [L 1975, c 161, pt of §1 and am c 41, §1; am L 1979, c 164, §1; am L 1998, c 204, §1]

Revision Note
Haw. Rev. Stat. § 435E-34 — HI Code / Division 2 / Title 24 / Chapter 435E / Section 435E-34
Peer review.
Status: in_force

(a) A peer review committee or committees shall be established by the trust agreement to review the qualifications of any physician and surgeon to participate or continue to participate in the interindemnity arrangement, and to review the quality of medical services rendered by any participating member, as well as the validity of medical malpractice claims made against participating members.

(b) Any physician and surgeon, prior to becoming a participating member of the interindemnity arrangement, shall be reviewed and approved by a majority of the members of the peer review committee.

(c) No peer review committee, or any of its members, shall be liable for any action taken by the committee in reviewing the qualifications of a physician and surgeon to participate or continue to participate, or the quality of medical services rendered, or the validity of a medical malpractice claim, unless it is alleged and proved that such action was taken with actual malice. [L 1977, c 182, pt of §1]
Haw. Rev. Stat. § 431N-3 — HI Code / Division 2 / Title 24 / Chapter 431N / Section 431N-3
State health insurance program established.
Status: in_force

There is established within the department of health the state health insurance program whose goals shall be to:

(1) Subsidize health care coverage for gap group individuals, including but not necessarily limited to outpatient primary and preventive care;

(2) Encourage the uninsured who can afford to participate in existing health plans to seek that coverage;

(3) Discourage individuals who are already adequately insured from seeking benefits under the state health insurance program;

(4) Assure that those persons who have the ability to pay for all or part of their coverage be appropriately assessed by the contractors on a sliding fee scale basis; and

(5) Ensure that the state health insurance program is affordable to gap group individuals.

The program shall be funded by legislative appropriations made to the department of health. [L 1989, c 378, pt of §1]
Haw. Rev. Stat. § 432C-2 — HI Code / Division 2 / Title 24 / Chapter 432C / Section 432C-2
Application for conversion.
Status: in_force

(a) A nonprofit entity shall file an application with the commissioner at least six months prior to a proposed conversion. The application shall include a report of the activities of the nonprofit entity and a plan for the conversion including the following:

(1) A board resolution indicating that a majority of the board of directors has approved the plan for conversion;

(2) Copies of the original and amended articles of incorporation, if any;

(3) The nature of the public benefit or charitable activities undertaken by the nonprofit entity;

(4) Expenditures incurred by the nonprofit entity on the public benefit or charitable activities;

(5) A means that establishes that the conversion shall not be prejudicial to the subscribers, contract holders, or residents of this State;

(6) A comparative premium rate analysis of the nonprofit entity's major plans and products, with the analysis comparing actual premium rates for the past three years prior to the proposed conversion and projected premium rates for three years following the proposed conversion. The analysis shall address the projected impact, if any, of the proposed conversion upon the nonprofit entity's future underwriting profit, investment income, and loss and claim reserves, including the effect, if any, of adverse market or risk selection upon the reserves; and

(7) A valuation of all assets held by the nonprofit entity.

(b) The commissioner may request any additional information that the commissioner deems necessary to carry out this chapter. [L 1998, c 260, pt of §2]
Haw. Rev. Stat. § 431N-5 — HI Code / Division 2 / Title 24 / Chapter 431N / Section 431N-5
Rulemaking authority.
Status: in_force

The director of health shall adopt rules in accordance with chapter 91 which are necessary to carry out this chapter. The rules shall include, but need not be limited to:

(1) Establishment of guidelines for the purchase of health care coverage from health care contractors by the department;

(2) Establishment of specific health care services to be covered, limited, and excluded by the program, including preventive services, outreach, and education strategies designed to reach gap group individuals;

(3) Establishment of eligibility requirements for participation in the program;

(4) Development and implementation of an identification and notification process for eligible program participants;

(5) Establishment of a payment schedule based on the person's ability to pay;

(6) Establishment of program participation criteria for health care contractors;

(7) Establishment of monitoring and evaluative guidelines for the program;

(8) Establishment of appeal procedures for denial of eligibility, disqualification from program participation, assessment of civil penalties, or other negative action; and

(9) Establishment of procedures to exclude or remove from the program persons who drop individual or group coverage to obtain insurance. [L 1989, c 378, pt of §1]
Haw. Rev. Stat. § 435E-42 — HI Code / Division 2 / Title 24 / Chapter 435E / Section 435E-42
Enforcement.
Status: in_force

Whenever it appears to the commissioner that any person has engaged or is about to engage in any act or practice constituting a violation of this chapter, the commissioner may in the commissioner's discretion bring an appropriate action in any circuit court of the State to enjoin the acts or practices or to otherwise enforce this chapter. Upon a proper showing a permanent or preliminary injunction, restraining order, or writ of mandate shall be granted and a receiver or conservator may be appointed for the defendant or the defendant's assets. The court shall not require the commissioner to post a bond.
Haw. Rev. Stat. § 431R-1 — HI Code / Division 2 / Title 24 / Chapter 431R / Section 431R-1
Definitions.
Status: in_force

As used in this chapter, unless the context indicates otherwise:

"Beneficiary of a prescription drug benefit plan" or "beneficiary" means a person who is a member, subscriber, enrollee, or dependent of a member, subscriber, or enrollee of or otherwise covered under a prescription drug benefit plan.

"Pharmacy benefit manager" means any person, business, or entity that performs pharmacy benefit management, including but not limited to a person or entity under contract with a pharmacy benefit manager to perform pharmacy benefit management on behalf of a managed care company, nonprofit hospital or medical service organization, insurance company, third-party payor, or health program administered by the State.

"Pharmacy benefit manager's retail pharmacy network" means a retail pharmacy located and licensed in the State and contracted by the pharmacy benefit manager to sell prescription drugs to beneficiaries of a prescription drug benefit plan administered by the manager.

"Prescription drug benefit plan" means an accident and sickness insurance plan or health benefits plan that includes coverage for prescription drugs. For the purposes of this definition, a "health benefits plan" has the same meaning as in section 87A-1.

"Prescription drug benefit plan provider" means a person who provides prescription drug coverage as part of an accident and health or sickness insurance contract or other type of health insurance or benefits plan that is offered by the person and is subject to regulation under article 10A of chapter 431, chapter 432, or chapter 432D.

"Retail community pharmacy" means a pharmacy, permitted by the board of pharmacy pursuant to section 461-14, that is open to the public, dispenses prescription drugs to the general public, and makes available face-to-face consultations between licensed pharmacists and the general public to whom prescription drugs are dispensed. [L 2013, c 226, pt of §2]
Haw. Rev. Stat. § 432D-34 — HI Code / Division 2 / Title 24 / Chapter 432D / Section 432D-34
[ §432D-34] Services provided by participating registered pharmacists; coverage.
Status: in_force

[ §432D-34] Services provided by participating registered pharmacists; coverage. (a) Each health maintenance organization policy, contract, plan, or agreement that is issued, amended, or renewed in the State on or after July 1, 2026, shall:

(1) Recognize pharmacists licensed pursuant to chapter 461 as participating providers;

(2) Provide coverage for a service provided by a participating registered pharmacist practicing within the scope of the participating registered pharmacist's license for purposes of health maintenance or treatment to the extent that the plan contract provides coverage for the same service rendered by another health care provider; and

(3) Pay or reimburse a pharmacist or pharmacy for the cost of a service provided by a pharmacist within the scope of the pharmacist's practice.

(b) For the purposes of this section, "participating registered pharmacist" means a registered pharmacist licensed pursuant to chapter 461 who has contracted with the health maintenance organization to provide health care services to its enrollees or subscribers. [L 2025, c 220, §4]
Haw. Rev. Stat. § 432C-1 — HI Code / Division 2 / Title 24 / Chapter 432C / Section 432C-1
Definitions.
Status: in_force

As used in this chapter:

"Commissioner" means the insurance commissioner.

"Conversion" means the transfer or sale of a significant amount of a nonprofit entity's assets to a for-profit entity or through any other means as determined by the commissioner. The department of commerce and consumer affairs' business registration division shall assist the commissioner in determining whether a conversion is about to occur or has occurred. As used in this definition, "significant" means twenty per cent or more of the assets of the nonprofit entity or an amount where the for-profit entity gains control or majority ownership of total assets of the nonprofit entity.

"For-profit entity" means a corporation organized under chapter 414, including a stock insurance company.

"Nonprofit entity" means any charitable organization operating pursuant to Title 26 United States Code section 501(c)(3), (4), (8), (9), (26), or 501(e), and whose primary purpose is to provide accident and health or sickness insurance coverage or any type of accident and health or sickness insurance benefits to its members or the public. [L 1998, c 260, pt of §2; am L 2002, c 40, §74; am L 2003, c 212, §124]
Haw. Rev. Stat. § 432E-12 — HI Code / Division 2 / Title 24 / Chapter 432E / Section 432E-12
Rules.
Status: in_force

The commissioner shall adopt rules pursuant to chapter 91 necessary for the purposes of this chapter.
Haw. Rev. Stat. § 431M-7 — HI Code / Division 2 / Title 24 / Chapter 431M / Section 431M-7
Preservation of certain benefits.
Status: in_force

Nothing in this chapter shall serve to prevent the offering or acceptance of benefits required by this chapter.
Haw. Rev. Stat. § 431R-2 — HI Code / Division 2 / Title 24 / Chapter 431R / Section 431R-2
Retail community pharmacies; retail pharmacy network; contractual agreements.
Status: in_force

(a) An otherwise qualified retail community pharmacy registered to do business in this State that requests to enter into a contractual retail pharmacy network agreement accepting the standard terms, conditions, formularies, or requirements relating to dispensing fees, payments, reimbursement amounts, or other pharmacy services shall be considered part of a pharmacy benefit manager's retail pharmacy network for purposes of a beneficiary's right to choose where to purchase covered prescription drugs under section 431R‑3.

(b) It shall be a violation of this section for a prescription drug benefit plan, health benefits plan under chapter 87A, or pharmacy benefit manager to refuse to accept an otherwise qualified retail community pharmacy as part of a pharmacy benefit manager's retail pharmacy network.

(c) A contractual retail pharmacy network agreement entered into under this section shall be renewed annually, unless agreed to by the parties. If a prescription drug benefit plan, health benefits plan under chapter 87A, or pharmacy benefit manager who has entered into a contractual retail pharmacy network agreement with a retail community pharmacy considers such retail community pharmacy no longer otherwise qualified, the prescription drug benefit plan, health benefits plan under chapter 87A, or pharmacy benefit manager may appeal the retail community pharmacy's qualifications with the insurance commissioner.

(d) The insurance commissioner shall determine the standards and requirements necessary for a retail community pharmacy to be deemed "otherwise qualified" for purposes of this section. [L 2013, c 226, pt of §2]
Haw. Rev. Stat. § 431P-6 — HI Code / Division 2 / Title 24 / Chapter 431P / Section 431P-6
Advisory committee.
Status: in_force

To assist it in implementing this chapter the fund may appoint an advisory committee consisting of:

(1) Not less than one individual who is employed or trained as a meteorologist and possesses knowledge of the history, trends, and nature of windstorms in the Pacific Ocean;

(2) Not less than one individual who is a member of the American Academy of Actuaries; and

(3) Not less than one individual who is a structural engineer licensed to practice in the State and is knowledgeable about local community building codes.

The fund may establish additional advisory committees as it may deem necessary in furtherance of this chapter. [L 1993, c 339, pt of §2]
Haw. Rev. Stat. § 431P-9 — HI Code / Division 2 / Title 24 / Chapter 431P / Section 431P-9
Powers of the commissioner.
Status: in_force

(a) For the purpose of ascertaining the fund's condition or compliance with this chapter, the commissioner shall examine the accounts, records, documents, and transactions of the fund at least once every three years commencing at the time the fund starts issuing policies of hurricane property insurance or more often if the commissioner deems advisable. The fund shall pay all reasonable and actually incurred expenses of the examination in accordance with section 431:2-306(b); provided that a detailed estimate of the expenses to be incurred shall be approved by the board prior to the examination. In the event the actual expenses incurred are in excess of ten per cent of the estimate, the commissioner shall communicate in writing to the board the reason for the excess expenses.

(b) The commissioner may exercise all of the commissioner's powers provided by law in the supervision and regulation of the fund, any servicing facility, and any other person or entity subject to the jurisdiction of the commissioner. [L 1993, c 339, pt of §2; am L Sp 1995, c 17, §4]
Haw. Rev. Stat. § 432G-9 — HI Code / Division 2 / Title 24 / Chapter 432G / Section 432G-9
Replacement coverage.
Status: in_force

(a) Any carrier providing replacement coverage with respect to group dental benefits within a period of sixty days from the date of discontinuance of a prior dental insurer contract or policy providing such dental benefits shall immediately cover all enrollees who were validly covered under the previous dental insurer contract or policy at the date of discontinuance and who would otherwise be eligible for coverage under the succeeding carrier's contract, regardless of any provisions of the contract relating to active employment.

(b) Except to the extent benefits for the condition would have been reduced or excluded under the prior carrier's contract or policy, no provision in a succeeding carrier's contract of replacement coverage which would operate to reduce or exclude benefits on the basis that the condition giving rise to a claim for benefits preexisted the effective date of the succeeding carrier's contract shall be applied with respect to those enrollees validly covered under the prior carrier's contract or policy on the date of discontinuance. [L 2013, c 191, pt of §1]
Haw. Rev. Stat. § 432D-4 — HI Code / Division 2 / Title 24 / Chapter 432D / Section 432D-4
Fiduciary responsibilities.
Status: in_force

(a) Any director, officer, employee, or partner of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of an organization shall be responsible for the funds in a fiduciary relationship to the organization.

(b) A health maintenance organization shall maintain in force a fidelity bond or fidelity insurance on such employees, officers, directors, and partners in an amount not less than $250,000 for each health maintenance organization or a maximum of $5,000,000 in aggregate maintained on behalf of health maintenance organizations owned by a common parent corporation, or such sum as may be prescribed by the commissioner. [L 1995, c 179, pt of §1]
Haw. Rev. Stat. § 431R-3 — HI Code / Division 2 / Title 24 / Chapter 431R / Section 431R-3
Prescription drugs; beneficiary choice; mail order opt out.
Status: in_force

(a) If a retail community pharmacy enters into a contractual retail pharmacy network agreement pursuant to section 431R-2, a prescription drug benefit plan, health benefits plan under chapter 87A, or pharmacy benefit manager shall permit each beneficiary, at the beneficiary's option, to fill any covered prescription that may be obtained by mail order at any retail community pharmacy of the beneficiary's choice within the pharmacy benefit manager's retail pharmacy network.

(b) A prescription drug benefit plan, health benefits plan under chapter 87A, or pharmacy benefit manager who has entered into a contractual retail pharmacy network agreement with a retail community pharmacy shall not:

(1) Require a beneficiary to exclusively obtain any prescription from a mail order pharmacy;

(2) Impose upon a beneficiary utilizing the retail community pharmacy a copayment, fee, or other condition not imposed upon beneficiaries electing to utilize a mail order pharmacy;

(3) Subject any prescription dispensed by a retail community pharmacy to a beneficiary to a minimum or maximum quantity limit, length of script, restriction on refills, or requirement to obtain refills not imposed upon a mail order pharmacy;

(4) Require a beneficiary in whole or in part to pay for any prescription dispensed by a retail community pharmacy and seek reimbursement if the beneficiary is not required to pay for and seek reimbursement in the same manner for a prescription dispensed by a mail order pharmacy;

(5) Subject a beneficiary to any administrative requirement to use a retail community pharmacy that is not imposed upon the use of a mail order pharmacy; or

(6) Impose any other term, condition, or requirement pertaining to the use of the services of a retail community pharmacy that materially and unreasonably interferes with or impairs the right of a beneficiary to obtain prescriptions from a retail community pharmacy of the beneficiary's choice. [L 2013, c 226, pt of §2]
Haw. Rev. Stat. § 431C-44 — HI Code / Division 2 / Title 24 / Chapter 431C / Section 431C-44
Mandatory reporting of fraudulent life settlement acts.
Status: in_force

(a) Any person engaged in the business of life settlements having knowledge or a reasonable belief that a fraudulent life settlement act is being, will be, or has been committed shall provide to the commissioner the information required by, and in a manner prescribed by, the commissioner.

(b) Any other person having knowledge or a reasonable belief that a fraudulent life settlement act is being, will be, or has been committed may provide to the commissioner the information required by, and in a manner prescribed by, the commissioner. [L 2012, c 256, pt of §1]
Haw. Rev. Stat. § 431R-5 — HI Code / Division 2 / Title 24 / Chapter 431R / Section 431R-5
Violations; penalties.
Status: in_force

(a) The insurance commissioner may assess a fine of up to $10,000 for each violation by a pharmacy benefit manager or prescription drug benefit plan provider who is in violation of section 431R-2 or 431R-3. In addition, the insurance commissioner may order the pharmacy benefit manager to take specific affirmative corrective action or make restitution.

(b) Failure of a pharmacy benefit manager to comply with a previously agreed upon contractual retail pharmacy network agreement pursuant to section 431R-2 or 431R-3 shall be an unfair or deceptive act or practice as provided in section 431:13-102.

(c) A pharmacy benefit manager or prescription drug benefit plan provider may appeal any decision made by the insurance commissioner in accordance with chapter 91.

(d) Every person and its officers, employees, and representatives subject to investigation or examination by the commissioner under this chapter shall produce and make freely accessible to the commissioner the accounts, records, documents, and files in the person's possession or control relating to the subject of the investigation or examination and shall otherwise facilitate the investigation or examination.

(e) Every person and its officers, employees, and representatives subject to investigation or examination by the commissioner under this chapter shall issue a written response no later than fifteen working days after receiving a written inquiry from the commissioner regarding a claim or complaint. The response shall be more than an acknowledgment that the commissioner's communication has been received and shall adequately address the concerns stated in the communication. [L 2013, c 226, pt of §2 ; am L 2016, c 141, §15 ]
Haw. Rev. Stat. § 435E-12 — HI Code / Division 2 / Title 24 / Chapter 435E / Section 435E-12
Trust corpus, contributions.
Status: in_force

There shall be an initial trust corpus of not less than $3,000,000 which corpus shall be a trust fund to secure enforcement of the interindemnity arrangement. The average initial contribution to such corpus shall be not less than $20,000 per member participating in the interindemnity arrangement. No such interindemnity arrangement shall become operative until the requisite minimum reserve trust fund has been established by such participating members. The commissioner shall have the power to investigate and verify the amounts specified by law.
Haw. Rev. Stat. § 432E-1.5 — HI Code / Division 2 / Title 24 / Chapter 432E / Section 432E-1.5
Licensure of managed care plan medical directors.
Status: in_force

The medical director of any managed care plan providing services in the State shall hold an unlimited license to practice medicine or osteopathic medicine in the State pursuant to chapter 453.
Haw. Rev. Stat. § 435E-43 — HI Code / Division 2 / Title 24 / Chapter 435E / Section 435E-43
Investigation, publication.
Status: in_force

The commissioner, in the commissioner's discretion, may:

(1) Make public or private investigations within or outside of this State as the commissioner deems necessary to determine whether any person has violated or is about to violate this chapter, or to aid in the enforcement of this chapter; and

(2) Publish information concerning the violation of this chapter. [L 1977, c 182, pt of §1; am L 1982, c 203, §16; gen ch 1985; am L 2018, c 18, §31]
Haw. Rev. Stat. § 431C-12 — HI Code / Division 2 / Title 24 / Chapter 431C / Section 431C-12
Conduct of examinations.
Status: in_force

(a) Upon determining that an examination under section 431C-11 should be conducted, the commissioner shall issue an examination warrant appointing one or more examiners to perform the examination and instructing them as to the scope of the examination. In conducting the examination, the examiner shall use methods common to the examination of any life settlement licensee and shall use the guidelines and procedures set forth in an examiners' handbook adopted by a national organization.

(b) Every licensee or person from whom information is sought, including its officers, directors, employees, and agents, shall provide to the examiners timely, convenient, and free access at all reasonable hours at its offices to all books, records, accounts, papers, documents, assets, and computer or other recordings relating to the property, assets, business, and affairs of the licensee being examined. The officers, directors, employees, and agents of the licensee or person shall facilitate the examination and aid in the examination so far as it is in their power to do so. The refusal of a licensee, by its officers, directors, employees, or agents, to submit to examination or to comply with any reasonable written request of the commissioner shall be grounds for suspension or refusal of, or nonrenewal of any license or authority held by the licensee to engage in the life settlement business or other business subject to the commissioner's jurisdiction. Any proceedings for suspension, revocation, or refusal of any license or authority shall be conducted pursuant to chapter 91.

(c) The commissioner shall have the power to issue subpoenas, to administer oaths, and to examine under oath any person as to any matter pertinent to the examination. Upon the failure or refusal of a person to obey a subpoena, the commissioner may petition a court of competent jurisdiction, and upon proper showing, the court may enter an order compelling the witness to appear and testify or produce documentary evidence.

(d) When making an examination under this chapter, the commissioner may retain attorneys, appraisers, independent actuaries, independent certified public accountants, or other professionals and specialists as examiners, the reasonable cost of which shall be borne by the licensee that is the subject of the examination.

(e) Nothing in this chapter shall be construed to limit the commissioner's authority to terminate or suspend an examination to pursue other legal or regulatory action pursuant to the insurance laws of this State. Findings of fact and conclusions made pursuant to any examination shall be prima facie evidence in any legal or regulatory action.

(f) Nothing in this chapter shall be construed to limit the commissioner's authority to use and, if appropriate, to make public any final or preliminary examination report, any examiner or licensee work papers or other documents, or any other information discovered or developed during the course of any examination in the furtherance of any legal or regulatory action that the commissioner may, in the commissioner's sole discretion, deem appropriate. [L 2012, c 256, pt of §1]
Haw. Rev. Stat. § 431C-6 — HI Code / Division 2 / Title 24 / Chapter 431C / Section 431C-6
Reporting requirements and privacy.
Status: in_force

(a) For any policy settled within five years of policy issuance, each provider shall file with the commissioner on or before March 1 of each year an annual statement containing the information as the commissioner may prescribe by rule. In addition to any other requirements, the annual statement shall:

(1) Specify the total number, aggregate face amount, and life settlement proceeds of policies settled during the immediately preceding calendar year, together with a breakdown of the information by policy issue year; and

(2) Include the names of the insurance companies whose policies have been settled and the brokers who have settled said policies.

The information shall be limited to only those transactions where the insured is a resident of this State and shall not include individual transaction data regarding the business of life settlements or information that there is a reasonable basis to believe could be used to identify the owner or the insured.

Every provider that wilfully fails to file an annual statement as required in this section, or wilfully fails to reply within thirty days to a written inquiry by the commissioner in connection therewith, in addition to other penalties provided by this chapter, and upon due notice and opportunity to be heard, shall be subject to a penalty of up to $250 per day of delay, not to exceed $25,000 in the aggregate, for each such failure.

(b) Except as otherwise allowed or required by law, a provider, broker, insurance company, insurance producer, information bureau, rating agency or company, or any other person with actual knowledge of an insured's identity, shall not disclose the identity of an insured or information that there is a reasonable basis to believe could be used to identify the insured or the insured's financial or medical information to any other person unless the disclosure:

(1) Is necessary to effect a life settlement contract between the owner and a provider, and the owner and insured have provided prior written consent to the disclosure;

(2) Is necessary to effectuate the sale of life settlement contracts, or interests therein, as investments, so long as the sale is conducted in accordance with applicable state and federal securities law and the owner and the insured have both provided prior written consent to the disclosure;

(3) Is provided in response to an investigation or examination by the commissioner pursuant to the requirements of section 431C-17 or any other governmental officer or agency;

(4) Is a term or condition to the transfer of a policy by one provider to another provider, in which case the receiving provider shall be required to comply with the confidentiality requirements of this section;

(5) Is necessary to allow the provider or broker or their authorized representatives to make contacts for the purpose of determining health status. For the purposes of this paragraph, the term "authorized representative" shall not include any person who has or may have any financial interest in the life settlement contract other than a provider, licensed broker, financing entity, related provider trust, or special purpose entity. A provider or broker shall require its authorized representative to agree in writing to adhere to the privacy provisions of this section; or

(6) Is required to purchase stop loss coverage.

(c) Non-public personal information solicited or obtained in connection with a proposed or actual life settlement contract shall be subject to the provisions applicable to financial institutions under the federal Gramm-Leach-Bliley Act, P.L. 106-102, and all other applicable state and federal laws relating to confidentiality of non-public personal information. [L 2012, c 256, pt of §1]
Haw. Rev. Stat. § 431M-6 — HI Code / Division 2 / Title 24 / Chapter 431M / Section 431M-6
Rules.
Status: in_force

The insurance commissioner, after consultation with all interested parties including the director of health, the Hawaii medical board, the board of psychology, and representatives of insurance carriers, nonprofit mutual benefit societies, health maintenance organizations, public and private providers, consumers, employers, and labor organizations shall adopt rules pursuant to chapter 91 as are deemed necessary for the effective implementation and operation of this chapter. The rules shall include criteria and guidelines to be used in determining the appropriateness and medical or psychological necessity of services covered under this chapter, including the appropriate level of care or place of treatment and the number or quantity of services, and shall include an appeals process.

The director of health shall also adopt rules pursuant to chapter 91 as are deemed necessary for the implementation and operation of this chapter. The rules shall provide certification standards that:

(1) Reflect quality of care; and

(2) Do not compromise the quality of care. [L 1988, c 202, pt of §1, §3; am L 1991, c 90, §2; am L 1994, c 111, §4; am L 1998, c 78, §3; am L 2002, c 239, §1; am L 2004, c 122, §83; am L 2008, c 9, §3; am L 2014, c 186, §12]