reglab/housing_qa huggingface dataset:
HI Rev Stat § 431:10A-125 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10A-125 Primary care provider; advanced practice registered nurse.

 §431:10A-125 Primary care provider; advanced practice registered nurse. (a) Each policy of accident and health or sickness insurance delivered or issued for delivery in this State shall recognize advanced practice registered nurses, as defined under section 457-8.5(a), as participating providers, and shall include coverage for care provided by participating advanced practice registered nurses practicing within the scope of their licenses for purposes of health maintenance, diagnosis, or treatment, to the extent that the policy provides benefits for identical services rendered by another health care provider.  (b) Notwithstanding any other law to the contrary, an insurer may recognize a participating advanced practice registered nurse as a primary care provider if the insured's policy requires the selection of a primary care provider. The insurer shall include participating advanced practice registered nurses who practice as primary care providers on any publicly available list of participating primary care providers; provided that the insurer retains the right to determine the contracting criteria for a participating primary care provider.  (c) For the purposes of this section, "participating advanced practice registered nurse" means an advanced practice registered nurse who has contracted with the insurer to provide health care services to its insureds. [L 2009, c 169, §2]
HI Rev Stat § 431:10A-126 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10A-126 Cancer treatment.

  §431:10A-126 Cancer treatment. (a) Notwithstanding section 23-51, all individual and group accident and health or sickness insurance policies that include coverage or benefits for the treatment of cancer shall provide payment or reimbursement for all types of chemotherapy that are considered medically necessary as defined in section 432E-1.4.  (b) The cost-sharing for generic and non-generic oral chemotherapy shall be provided at the same or lower amount or percentage as is applied to generic and non-generic intravenously administered chemotherapy; provided that an insurer shall not increase the cost-share for intravenously administered chemotherapy in order to achieve compliance with this subsection.  (c) Individual and group accident and health or sickness insurance policies shall not increase enrollee cost-sharing for non-generic medications used for the treatment of cancer to any greater extent than such policies increase enrollee cost-sharing for other covered non-generic medication.  (d) For the purposes of this section:  "Cost-share" or "cost-sharing" means copayment, coinsurance, or deductible provisions applicable to coverage for medications or treatments.  "Intravenously administered chemotherapy" means a physician-prescribed cancer treatment that is administered through injection directly into the patient's circulatory system by a physician, physician assistant, nurse practitioner, nurse, or other medical personnel under the supervision of a physician and in a hospital, medical office, or other clinical setting.  "Oral chemotherapy" means a United States Food and Drug Administration-approved, physician-prescribed cancer treatment that is taken orally in the form of a tablet or capsule and may be administered in a hospital, medical office, or other clinical setting or may be delivered to the patient for self-administration under the direction or supervision of a physician outside of a hospital, medical office, or other clinical setting.  (e) This section shall not apply to an accident-only, specified disease, hospital indemnity, long-term care, or other limited-benefit health insurance policy. [L 2009, c 168, §1; am L 2012, c 30, §1]
HI Rev Stat § 431:10A-131 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10A-131 REPEALED.

  §431:10A-131 REPEALED. L 2009, c 149, §9. Cross References  Insurance fraud, see § §431:2-401 to 431:2-410.
HI Rev Stat § 431:10A-134 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10A-134 Human immunodeficiency virus and acquired immunodeficiency syndrome screening coverage.

 §431:10A-134 Human immunodeficiency virus and acquired immunodeficiency syndrome screening coverage. (a) Each policy of accident and health or sickness insurance issued or renewed in this State, except for policies that only provide coverage for specified diseases or other limited benefit coverage as described in section 431:10A-607, shall provide coverage for annual screenings for sexually transmitted diseases, including screenings for human immunodeficiency virus and acquired immunodeficiency syndrome.  (b) Each accident and health or sickness insurer shall reimburse all costs associated with the coverage under subsection (a) to any physician or health care provider complying with this section. [L 2016, c 204, §2; am L 2019, c 70, §33] Note  Applicability of section. L 2016, c 204, § §6, 8.
HI Rev Stat § 431:10A-140 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10A-140 Formulary; accessibility requirements.

  §431:10A-140 Formulary; accessibility requirements. (a) Each insurer offering or renewing an individual or group accident and health or sickness insurance policy on or after January 1, 2017, shall provide the following information via a public website and through a toll-free number that is posted on the insurer's website:  (1) Its formulary; provided that notice of any changes due to the addition of a new drug or deletion of any existing drug shall be made available no later than seventy-two hours after the effective date of the change; provided further that notice of other changes, including drug strength or form, shall be made available within fourteen calendar days of the effective date of the change;  (2) Provide a system that allows an insured or potential insured to determine whether prescription drugs are covered under the plan's medical benefits and typically administered by a provider, along with any cost-sharing imposed on such drugs;  (3) Indicate a dollar amount range of cost-sharing typically paid by an insured of each specific drug included on the formulary based on the information the insurer has available, as follows:  (A) $100 and under: $;  (B) Over $100 to $250: $$;  (C) Over $250 to $500: $$$;  (D) Over $500 to $1,000: $$$$; and  (E) Over $1,000: $$$$$; and  (4) Display standardized content for the formulary for each product offered by the plan pursuant to recommendations made by the formulary accessibility working group established pursuant to Act 197, Session Laws of Hawaii 2015.  (b) For the purposes of this section, "formulary" means the complete list of drugs preferred for use and eligible for coverage under a policy, including drugs covered under the policy's pharmacy benefit and medical benefit as defined by the health care service plans.  (c) This section shall not apply to limited benefit health insurance as provided in section 431:10A-607; provided further that this section shall not apply to medicare, medicaid, or other federally financed plans. [L 2015, c 197, §1; am L 2019, c 70, §33]
HI Rev Stat § 431:10A-141 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10A-141 Extension of dependent coverage.

  §431:10A-141 Extension of dependent coverage. An individual policy of accident and health or sickness insurance and a health insurer offering individual accident and health or sickness insurance coverage 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 or health insurer to make coverage available for a child of a child receiving dependent coverage. [L 2018, c 111, pt of §2]
HI Rev Stat § 431:10A-142 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10A-142 Prohibition of preexisting condition exclusions.

  §431:10A-142 Prohibition of preexisting condition exclusions. (a) No individual policy of accident and health or sickness insurance 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 policy of accident and health or sickness insurance, 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 policy of accident and health or sickness insurance, such as a condition identified as a result of a pre-enrollment questionnaire or physical examination given to the individual or a review of medical records relating to the pre-enrollment period. [L 2018, c 111, pt of §2]
HI Rev Stat § 431:10A-143 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10A-143 Prohibited discrimination in premiums or contributions.

  §431:10A-143 Prohibited discrimination in premiums or contributions. No individual policy of accident and health or sickness insurance and no health insurer offering individual accident and health or sickness insurance coverage issued or renewed in this State shall require an individual, as a condition of enrollment or continued enrollment under the policy, 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 or a substantially similar policy offered by the same insurer. [L 2018, c 111, pt of §2]
HI Rev Stat § 431:10A-144 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10A-144 Reimbursement to providers.

 §431:10A-144 Reimbursement to providers. (a) Coverage for services required by this part shall include reimbursement to health care providers who perform services required by this part, or to the insured member, as appropriate.  (b) Whenever an individual or group policy, contract, plan, or agreement provides for reimbursement for any service, a health care provider who performs a service shall be eligible for reimbursement for the performed service to the extent the health care provider is eligible for such reimbursement under the policy, contract, plan, or agreement, and is acting within the scope of the provider's license or certification under state law.  (c) For purposes of this section, "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); and a practitioner licensed by the State and working within the practitioner's scope of practice. [L 2019, c 70, pt of §2]
HI Rev Stat § 431:10A-202 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10A-202 Health care groups.

  §431:10A-202 Health care groups. A policy of group disability insurance may be issued to a corporation, as policyholder, existing primarily for the purpose of assisting individuals who are its subscribers in securing medical, hospital, dental, and other health care services for themselves and their dependents, covering all and not less than five hundred such subscribers and dependents, with respect only to medical, hospital, dental, and other health care services. [L 1987, c 347, pt of §2]
HI Rev Stat § 431:10A-203 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10A-203 Standard provisions.

  §431:10A-203 Standard provisions.  Every policy of group or blanket disability insurance shall contain in substance the following provisions, or provisions which in the opinion of the commissioner are more favorable to the individuals insured, or at least as favorable to such individuals and more favorable to the policyholder. No such policy of group or blanket disability insurance shall contain any provision relative to notice or proof of loss, or to the time for paying benefits, or to the time within which suit may be brought upon the policy, which in the opinion of the commissioner is less favorable to the individuals insured than would be permitted by the standard provisions required for individual accident and health or sickness insurance policies.  (1) Representations. There shall be a provision that:  (A) All statements, made by the policyholder or by the individuals insured, shall be deemed to be representations and not warranties;  (B) No statement, made in the application by the policyholder, shall be used in any contest unless a copy of the application, if any, of the policyholder shall be attached to the policy when issued;  (C) No statement made by any individual insured shall be used in any contest unless a copy of the instrument containing the statement is or has been furnished to such individual or to the individual's beneficiary, if any; and  (D) A misrepresentation, unless it is made with actual intent to deceive or unless it materially affects either the acceptance of the risk or the hazard assumed by the insurer, shall not prevent a recovery on the policy.  (2) Certificates. There shall be a provision that the insurer shall issue to the policyholder for delivery to each insured employee or member, an individual certificate setting forth in summary form a statement of the essential features of the insurance coverage, and to whom the benefits are payable. If family members are insured, only one certificate need be issued for each family. This paragraph shall not apply to blanket disability insurance policies.  (3) Additional insureds. There shall be a provision that to the group originally insured may be added, from time to time, eligible new employees, members, or dependents, as the case may be, in accordance with the terms of the policy.  (4) Age limitations. There shall be a provision specifying:  (A) The ages, if any, to which the insurance provided shall be limited;  (B) The ages, if any, for which additional restrictions are placed on benefits; and  (C) The additional restrictions placed on the benefits at such ages.  (5) Payment of premiums. There shall be a provision that all premiums due under the policy shall be remitted by the employer or employers of the persons insured, by the policyholder or by some other designated person acting on behalf of the association or group insured, to the insurer on or before the due date thereof within such grace period as may be specified therein. [L 1987, c 347, pt of §2; am L 1989, c 195, §24; am L 2002, c 155, §61]
HI Rev Stat § 431:10A-204 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10A-204 Optional provision, examination and autopsy.

  §431:10A-204 Optional provision, examination and autopsy. There may be a provision that the insurer shall have the right and opportunity to examine the person of any individual covered under the policy when and so often as it may reasonably require during the pendency of claim under the policy and also the right and opportunity to make an autopsy in case of death where it is not prohibited by law. [L 1987, c 347, pt of §2]
HI Rev Stat § 431:10A-205 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10A-205 Payment of benefits.

  §431:10A-205 Payment of benefits. (a) The benefits payable under any policy or contract of group or blanket disability insurance shall be payable to the insured member of the group or to the beneficiary designated by the insured member, other than the policyholder, subject to provisions of the policy in the event the claimant is insane or otherwise incompetent, or in the event there is no designated beneficiary as to all or any part of any sum payable at the death of the individual insured; provided, that if the entire cost of the insurance has been borne by the employer such benefits may be made payable to the employer.  (b) Any group or blanket disability policy may provide that all or any portion of any indemnities provided by the policy on account of hospital, nursing, medical, or surgical services may, at the insurer's option, be paid directly to the hospital or person rendering such services, but the policy may not require that the service be rendered by a particular hospital or person. Payment so made shall discharge the insurer's obligation with respect to the amount so paid.  (c) No group disability income policy shall contain any provision integrating the benefits of the policy with social security benefits whereby the amount of the disability benefit actually being paid to the disabled person under the terms and conditions of the policy will be diminished when there occurs an increase in social security benefits either by operation of amendments to the Social Security Act or by cost of living adjustments which become effective after the first day the disabled person becomes entitled to benefits. [L 1987, c 347, pt of §2] Case Notes  Properly licensed HMOs, like plaintiff, were authorized pursuant to §432D-1 to "provide or arrange", at their option, for the closed panel health care services required under the managed care plan program; accident and health insurers were authorized under subsection (b) to arrange for medical services for members using a defined network of providers, i.e., particular "hospitals or persons"; thus, article 431:10A and chapter 432D authorized both accident and health insurers and HMOs, as risk-bearing entities, to provide the closed panel product required by the managed care plan contracts. 126 H. 326, 271 P.3d 621 (2012).
HI Rev Stat § 431:10A-206 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10A-206 Coverage of newborn children.

  §431:10A-206 Coverage of newborn children.  All group or blanket disability policies providing family coverage, as defined in section 431:10A-103 and reciprocal beneficiary family coverage, as defined in section 431:10A-601, on an expense incurred basis shall provide coverage for newborn children in compliance with section 431:10A-115. [L 1987, c 347, pt of §2; am L 1997, c 383, §7; am L 2002, c 155, §62]
HI Rev Stat § 431:10A-207 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10A-207 Coverage for specific services.

  §431:10A-207 Coverage for specific services.  Every person insured under a group or blanket disability insurance policy shall be entitled to the reimbursements and coverages specified in section 431:10A-116. [L 1987, c 347, pt of §2; am L 2002, c 155, §63]
HI Rev Stat § 431:10A-208 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10A-208 Qualified medical child support order.

  §431:10A-208 Qualified medical child support order. (a) An employer, who provides health coverage to dependent children of an employee, shall recognize a child identified in a qualified medical child support order as an eligible dependent without regard to any enrollment season restrictions.  (b) A qualified medical child support order shall:  (1) Specify the name and last known mailing address, if any, of the plan member and the name and mailing address of each recipient child covered by the order;  (2) Include a reasonable description of the type of coverage to be provided to the recipient child, or the manner in which the type of coverage is to be determined;  (3) State the period during which it applies;  (4) Specify the plan to which it applies; and  (5) Not require a plan to provide any type or form of benefit or option that the plan does not otherwise provide. [L 1994, c 145, §2]
HI Rev Stat § 431:10A-209 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10A-209 Association health plan policy; compliance with state law.

  §431:10A-209 Association health plan policy; compliance with state law. (a) Every association health plan policy issued in this State shall comply with all laws of this State, regardless of the domicile of the association that has issued the policy.  (b) For the purposes of this section, "association health plan policy" means a policy issued by a voluntary association of employers formed in this State or another state that is authorized to issue association health plans under the regulations of the United States Department of Labor. [L 2018, c 199, §2]
HI Rev Stat § 431:10A-210 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10A-210 Extension of dependent coverage.

  §431:10A-210 Extension of dependent coverage. A group policy of accident and health or sickness insurance and a health insurer offering group accident and health or sickness insurance coverage 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 or health insurer to make coverage available for a child of a child receiving dependent coverage. [L 2018, c 111, pt of §3]
HI Rev Stat § 431:10A-211 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10A-211 Prohibition of preexisting condition exclusions.

  §431:10A-211 Prohibition of preexisting condition exclusions. (a) No group policy of accident and health or sickness insurance 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 a group policy of accident and health or sickness insurance, 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 a group policy of accident and health or sickness insurance, 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 §3]
HI Rev Stat § 431:10A-212 (2021)
2021 Hawaii Revised Statutes|Title 24. Insurance|431. Insurance Code|431:10A-212 Prohibited discrimination in premiums or contributions.

  §431:10A-212 Prohibited discrimination in premiums or contributions. No group policy of accident and health or sickness insurance and no health insurer offering group accident and health or sickness insurance coverage issued or renewed in this State shall require an individual, as a condition of enrollment or continued enrollment under the policy, 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 or a substantially similar policy offered by the same insurer. [L 2018, c 111, pt of §3]