reglab/housing_qa huggingface dataset:
HI Rev Stat § 432D-30 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|432D. Health Maintenance Organization Act|432D-30 Medication synchronization; proration; dispensing fees.

  §432D-30 Medication synchronization; proration; dispensing fees. (a) Each health maintenance organization policy, contract, plan, or agreement that provides prescription drug coverage in the State shall apply a prorated daily cost-sharing rate to prescriptions that are dispensed by a network pharmacy for less than a thirty-day supply for the purpose of medication synchronization; provided that the enrollee patient requests or agrees to less than a thirty-day supply.  (b) For the purposes of medication synchronization under this section, the health maintenance organization that provides prescription drug coverage shall:  (1) Not deny coverage for the dispensing of a maintenance medication that is dispensed by a network pharmacy on the basis that the dispensed amount is a partial supply and the enrollee patient requests or agrees to a partial supply; and  (2) Authorize a network pharmacy to override any denial codes indicating that a prescription is being refilled too soon.  (c) No policy, contract, plan, or agreement providing prescription drug coverage shall use payment structures incorporating prorated dispensing fees. Dispensing fees for partially filled or refilled prescriptions shall be paid in full for each prescription dispensed, regardless of any prorated copayment for the beneficiary or fee paid for medication synchronization services.  (d) A network pharmacy shall identify an anchor prescription to which all other prescriptions may be subject to medication synchronization; provided that any medication dispensed in an unbreakable package shall not be considered the anchor prescription for purposes of this section.  (e) No schedule II narcotic controlled substance listed in section 329-16 shall be eligible for medication synchronization.  (f) For purposes of this section:  "Medication synchronization" means the coordination of medication refills that are being dispensed by a single contracted pharmacy to an enrollee patient taking two or more medications for one or more chronic conditions so that the patient's medications are refilled on the same schedule for a given time period.  "Unbreakable package" means a medication form or package that is to be dispensed in its original container. The term "unbreakable package" includes but is not limited to eye drops, inhalers, creams, and ointments. [L 2018, c 197, §4]
HI Rev Stat § 432D-31 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|432D. Health Maintenance Organization Act|432D-31 Extension of dependent coverage.

 §432D-31 Extension of dependent coverage. Each individual or group policy, contract, plan, or agreement and each health maintenance organization offering individual or group policies, contracts, plans, or agreements that provides dependent coverage of children shall continue to make that coverage available for an adult child until the child turns twenty-six years of age. Nothing in this section shall require a policy, contract, plan, or agreement to make coverage available for a child of a child receiving dependent coverage. [L 2018, c 111, pt of §5]
HI Rev Stat § 432D-32 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|432D. Health Maintenance Organization Act|432D-32 Prohibition of preexisting condition exclusions.

  §432D-32 Prohibition of preexisting condition exclusions. (a) No individual or group health maintenance organization policy, contract, plan, or agreement issued or renewed in this State shall impose any preexisting condition exclusion.  (b) For purposes of this section, a "preexisting condition exclusion" means a limitation or exclusion of benefits, including a denial of coverage, based on the fact that the condition was present before the effective date of coverage (or if coverage is denied, the date of the denial) under an individual or group health maintenance organization policy, contract, plan, or agreement, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before that day and includes any condition.  The term "preexisting condition exclusion" includes any limitation or exclusion of benefits, including a denial of coverage, applicable to an individual as a result of information relating to an individual's health status before the individual's effective date of coverage (or if coverage is denied, the date of the denial) under an individual or group health maintenance organization policy, contract, plan, or agreement, such as a condition identified as a result of a pre-enrollment questionnaire or physical examination given to the individual, or review of medical records relating to the pre-enrollment period. [L 2018, c 111, pt of §5]
HI Rev Stat § 432D-33 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|432D. Health Maintenance Organization Act|432D-33 Prohibited discrimination in premiums or contributions.

  §432D-33 Prohibited discrimination in premiums or contributions. No individual or group policy, contract, plan, or agreement and no health maintenance organization offering group or individual policies, contracts, plans, or agreements issued or renewed in this State shall require an individual, as a condition of enrollment or continued enrollment under a policy, contract, plan, or agreement, to pay a premium or contribution based on the individual's gender that is greater than the premium or contribution for a similarly situated individual of the opposite gender who is covered under the same policy, contract, plan, or agreement or a substantially similar policy, contract, plan, or agreement offered by the same health maintenance organization. [L 2018, c 111, pt of §5]
HI Rev Stat § 432E-1.5 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|432E. Patients' Bill of Rights and Responsibilities Act|432E-1.5 Licensure of managed care plan medical directors.

  §432E-1.5 Licensure of managed care plan medical directors. 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. [L 1999, c 273, §1; am L 2009, c 11, §55]
HI Rev Stat § 432E-2 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|432E. Patients' Bill of Rights and Responsibilities Act|432E-2 Conflict with other laws.

  §432E-2 Conflict with other laws. If there is a conflict with any other law, this chapter shall prevail to the extent that this chapter offers greater protection or rights to the enrollee. [L 1998, c 178, pt of §2]
HI Rev Stat § 432E-3 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|432E. Patients' Bill of Rights and Responsibilities Act|432E-3 REPEALED.

Note Sections 432E-3 through 432E-8 designated as Part II by L 2011, c 230, §4.   §432E-3 REPEALED. L 2013, c 192, §5.
HI Rev Stat § 432E-4 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|432E. Patients' Bill of Rights and Responsibilities Act|432E-4 Enrollee participation in treatment decisions.

  §432E-4 Enrollee participation in treatment decisions. (a)  An enrollee shall have the right to be informed fully prior to making any decision about any treatment, benefit, or nontreatment.  (b) In order to inform enrollees fully, the provider shall:  (1) Discuss all treatment options with an enrollee, as provided by section 671-3, including the option of no treatment at all;  (2) Ensure that persons with disabilities have an effective means of communication with the provider and other members of the managed care plan; and  (3) Discuss all risks, benefits, and consequences to treatment and nontreatment, as provided by section 671-3(b).  (c) The provider shall discuss with the enrollee and the enrollee's immediate family both [advance] health-care directives, as provided for in chapter 327E, and durable powers of attorney in relation to medical treatment.  (d) A managed care plan shall be prohibited from imposing any type of prohibition, disincentive, penalty, or other negative treatment upon a provider for discussing or providing any information regarding treatment options and medically necessary or appropriate care, including no treatment, even if the information relates to services or benefits not provided by the managed care plan. [L 1998, c 178, pt of §2; am L 2003, c 114, §1; am L 2005, c 22, §30; am L 2014, c 22, §3]
HI Rev Stat § 432E-5 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|432E. Patients' Bill of Rights and Responsibilities Act|432E-5 Complaints and appeals procedure for enrollees.

  §432E-5 Complaints and appeals procedure for enrollees. (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]
HI Rev Stat § 432E-6 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|432E. Patients' Bill of Rights and Responsibilities Act|432E-6 REPEALED.

  §432E-6 REPEALED. L 2011, c 230, §10.
HI Rev Stat § 432E-6.5 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|432E. Patients' Bill of Rights and Responsibilities Act|432E-6.5 Expedited internal appeal, when authorized; standard for decision.

  §432E-6.5 Expedited internal appeal, when authorized; standard for decision. (a) An enrollee may request that the internal appeal under section 432E-5 be conducted as an expedited appeal. If a request for expedited appeal is approved by the health carrier, the appropriate internal appeal shall be completed within seventy-two hours of receipt of the request for expedited appeal.  (b) An expedited appeal shall be authorized if the application of the sixty day standard review time frame may:  (1) Seriously jeopardize the life or health of the enrollee;  (2) Seriously jeopardize the enrollee's ability to gain maximum functioning; or  (3) Subject the enrollee to severe pain that cannot be adequately managed without the care or treatment that is the subject of the expedited appeal.  (c) The decision as to whether an enrollee's complaint is an expedited appeal shall be made by applying the standard of a reasonable individual who is not a trained health professional. The decision may be made for the managed care plan by an individual acting on behalf of the managed care plan. If a licensed health care provider with knowledge of a claimant's medical condition requests an expedited appeal on behalf of an enrollee, the request shall be treated as an expedited appeal. [L 2000, c 250, §2; am L 2004, c 27, §2; am L 2011, c 230, § §8, 9]
HI Rev Stat § 432E-7 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|432E. Patients' Bill of Rights and Responsibilities Act|432E-7 Information to enrollees.

  §432E-7 Information to enrollees. (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]
HI Rev Stat § 432E-8 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|432E. Patients' Bill of Rights and Responsibilities Act|432E-8 Enforcement.

  §432E-8 Enforcement. All remedies, penalties, and proceedings in articles 2 and 13 of chapter 431 made applicable hereby to managed care plans shall be invoked and enforced solely and exclusively by the commissioner. [L 1998, c 178, pt of §2]
HI Rev Stat § 432E-9 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|432E. Patients' Bill of Rights and Responsibilities Act|432E-9 Utilization review.

Note Sections 432E-9 through 432E-13 designated as Part III by L 2011, c 230, §5.   §432E-9 Utilization review. (a) Every managed care plan shall establish procedures for continuous review of quality of care, performance of providers, utilization of health services, facilities, and costs.  (b) Notwithstanding any other provision of law, there shall be no monetary liability on the part of, and no cause of action for damages shall arise against, any person who participates in quality of care or utilization reviews by peer review committees for any act performed during the reviews if the person acts without malice, makes a reasonable effort to obtain the facts, and believes that the action taken is warranted by the facts.   (c) No peer review committee under this section shall be subject to discovery, and no person in attendance at the reviews shall be required to testify as to what transpired at the reviews. The utilization review requirements and administrative treatment guidelines of the health maintenance organization shall not fall below the appropriate standard of care and shall not impinge upon the independent medical judgment of the treating health care provider.  (d) Nothing in this section shall be construed to prevent a health maintenance organization from conducting a utilization review and quality assurance program. [L 1998, c 178, pt of §2]
HI Rev Stat § 432E-11 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|432E. Patients' Bill of Rights and Responsibilities Act|432E-11 Accreditation of managed care plans.

  §432E-11 Accreditation of managed care plans. (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]
HI Rev Stat § 432E-12 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|432E. Patients' Bill of Rights and Responsibilities Act|432E-12 Rules.

  §432E-12 Rules. The commissioner shall adopt rules pursuant to chapter 91 necessary for the purposes of this chapter. [L 1999, c 137, pt of §2]
HI Rev Stat § 432E-13 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|432E. Patients' Bill of Rights and Responsibilities Act|432E-13 Annual report.

  §432E-13 Annual report. The commissioner shall submit annually to the legislature a report that shall contain the number of external review hearing cases reviewed, the type of cases reviewed, a summary of the nature of the cases reviewed, and the disposition of the cases reviewed. The identities of the plan and the enrollee shall be protected from disclosure in the report. [L 1999, c 137, pt of §2]
HI Rev Stat § 432E-31 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|432E. Patients' Bill of Rights and Responsibilities Act|432E-31 Applicability and scope.

Note The amendments made to this chapter by L 2011, c 230 have a transitional effective date and are subject to the insurance commissioner's emergency rulemaking authority for conformance to the federal Patient Protection and Affordable Care Act and a conditional repeal and reenactment provision. L 2011, c 230, § §14, 17.  §432E-31 Applicability and scope. (a) Except as provided in subsection (b), this part shall apply to all health carriers.  (b) This part shall not apply to a policy or certificate that provides coverage only for a specified disease, specified accident or accident-only coverage, credit, dental, disability income, hospital indemnity, long-term care insurance, vision care, or any other limited supplemental benefit; to a medicare supplemental policy of insurance, coverage under a plan through medicare, medicaid, or the federal employees health benefits program, any federal medical and dental care coverage issued under chapter 55 of title 10 United States Code and any coverage issued as supplemental to that coverage; any coverage issued as supplemental to liability insurance, workers' compensation, or similar insurance; automobile medical-payment insurance; any insurance under which benefits are payable with or without regard to fault, whether written on a group blanket or individual basis; or the employer union health benefits trust fund so long as it is self-funded. [L 2011, c 230, pt of §2]
HI Rev Stat § 432E-32 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|432E. Patients' Bill of Rights and Responsibilities Act|432E-32 Notice of right to external review.

  §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. [L 2011, c 230, pt of §2]
HI Rev Stat § 432E-33 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|432E. Patients' Bill of Rights and Responsibilities Act|432E-33 Request for external review.

  §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]
HI Rev Stat § 432E-37 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|432E. Patients' Bill of Rights and Responsibilities Act|432E-37 Binding nature of external review decision.

  §432E-37 Binding nature of external review decision. (a) An external review decision shall be binding on the health carrier and the enrollee except to the extent that the health carrier or the enrollee has other remedies available under applicable federal or state law.  (b) An enrollee or the enrollee's appointed representative shall not file a subsequent request for external review involving the same adverse action for which the enrollee has already received an external review decision pursuant to this part. [L 2011, c 230, pt of §2]