reglab/statecodes huggingface dataset:
2023 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]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-301 Definitions.

Attorney General Opinions
Section 431:10A-601 applied to all parts of article 10A if the category of policy under consideration included family coverage, as defined in §431:10A-103. Att. Gen. Op. 97-10.
§431:10A-301 Definitions.
For the purposes of this part:
"Applicant" means:
(1) In the case of an individual medicare supplement policy, the person who seeks to contract for insurance benefits, and
(2) In the case of a group medicare supplement policy, the proposed certificate holder.
"Certificate" means any certificate delivered or issued for delivery in this State under a group medicare supplement policy.
"Certificate form" means the form on which the certificate is delivered or issued for delivery by the issuer.
"Issuer" includes insurance companies, fraternal benefit societies, health care service plans, health maintenance organizations, and any other entity delivering or issuing for delivery in this State medicare supplement policies or certificates.
"Medicare" means the Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended.
"Medicare supplement policy" means a group or individual policy of accident and health or sickness insurance or a subscriber contract of hospital and medical service associations or health maintenance organizations, other than a policy issued pursuant to a contract under section 1876 of the federal Social Security Act (42 U.S.C. section 1395 et seq.), or an issued policy under a demonstration project specified in 42 U.S.C. section 1395ss(g)(1), which is advertised, marketed, or designed primarily as a supplement to reimbursements under medicare for the hospital, medical, or surgical expenses of persons eligible for medicare.
"Policy form" means the form on which the policy is delivered or issued for delivery by the issuer. [L 1987, c 347, pt of §2; am L 1989, c 195, §25; am L 1990, c 84, §1; am L 1992, c 195, §1; am L 1996, c 28, §1; am L 2003, c 212, §78]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-302 Applicability and scope.

§431:10A-302 Applicability and scope.
(a) Notwithstanding any provision in this part to the contrary, this part shall apply to:
(1) All medicare supplement policies delivered or issued for delivery in this State; and
(2) All certificates issued under group medicare supplement policies, which certificates have been delivered or issued for delivery in this State.
(b) This part shall not apply to a policy of one or more employers or labor organizations, or of the trustees of a fund established by one or more employers or labor organizations, or combination thereof, for employees or former employees, or combination thereof, or for members or former members, or combination thereof, of the labor organizations.
(c) The commissioner shall have all rights and powers with respect to the group or master policy and certificate issued pursuant to the medicare supplement policy as if the group or master policy was issued and delivered to a person domiciled in this State.
(d) Except as otherwise specifically provided in section 431:10A-307(d), this part is not intended to prohibit or apply to insurance policies or health care benefit plans including group conversion policies, issued to medicare eligible persons that are not marketed or held to be medicare supplement policies or benefit plans. [L 1987, c 347, pt of §2; am L 1989, c 207, §11; am L 1990, c 84, §2; am L 1992, c 195, §2; am L 1996, c 28, §2; am L 2004, c 122, §34]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-304 Standards for policy provisions.

§431:10A-304 Standards for policy provisions.
(a) No medicare supplement policy or certificate in force in the State shall contain benefits that duplicate benefits provided by medicare.
(b) The commissioner shall adopt reasonable rules to establish specific standards for the provisions of medicare supplement policies and certificates. The standards shall be in addition to and in accordance with applicable laws of this State, including the provisions of part I of this article. No requirement of this chapter relating to minimum required policy benefits, other than the minimum standards contained in this part, shall apply to medicare supplement policies and certificates. The standards may cover, but shall not be limited to:
(1) Terms of renewability;
(2) Initial and subsequent conditions of eligibility;
(3) Nonduplication of coverage;
(4) Probationary periods;
(5) Benefit limitations, exceptions, and reductions;
(6) Elimination periods;
(7) Requirements for replacement;
(8) Recurrent conditions; and
(9) Definition of terms.
(c) The commissioner may adopt reasonable rules that specify prohibited policy provisions not otherwise specifically authorized by law, which, in the opinion of the commissioner, are unjust, unfair, or unfairly discriminatory to any person insured or proposed to be insured under any medicare supplement policy or certificate.
(d) A medicare supplement policy or certificate shall not exclude or limit benefits for losses incurred more than six months after the effective date of coverage because it involved a preexisting condition. The policy or certificate shall not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage. [L 1987, c 347, pt of §2; am L 1989, c 195, §26; am L 1990, c 84, §3; am L 1992, c 195, §3]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-305 Rules.

§431:10A-305 Rules.
(a) The commissioner shall adopt reasonable rules to establish minimum standards for benefits and claims payment, marketing practices, compensation arrangements, and reporting practices for medicare supplement policies and certificates.
(b) The commissioner may adopt from time to time, reasonable rules as are necessary to conform medicare supplement policies and certificates to the requirements of federal law and regulations adopted thereunder, including but not limited to:
(1) Requiring refunds or credits if the policies or certificates do not meet loss ratio requirements;
(2) Establishing a uniform methodology for calculating and reporting loss ratios;
(3) Assuring public access to policies, premiums, and loss ratio information of issuers of medicare supplement insurance;
(4) Establishing a process for approving or disapproving policy forms and certificate forms and proposed premium increases;
(5) Establishing a policy for holding public hearings prior to approval of premium increases; and
(6) Establishing standards for medicare select policies and certificates. [L 1987, c 347, pt of §2; am L 1989, c 195, §27; am L 1990, c 84, §4; am L 1992, c 195, §4; am L 1993, c 205, §23; am L 1996, c 28, §3]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-306 Loss ratio standards.

§431:10A-306 Loss ratio standards.
Medicare supplement policies shall return to policyholders benefits which are reasonable in relation to the premium charged. The commissioner shall adopt reasonable rules to establish minimum standards for loss ratios of medicare supplement policies on the basis of incurred claims experience or incurred health care expenses where coverage is provided by a health maintenance organization on a service rather than reimbursement basis, and earned premiums in accordance with accepted actuarial principles and practices. For the purposes of rules adopted under this section, group medicare supplement policies and certificates issued as a result of solicitations of individuals through the mail or mass media advertising, including both print and broadcast advertising, shall be regarded as group policies. [L 1987, c 347, pt of §2; am L 1989, c 195, §28; am L 1990, c 84, §5; am L 1992, c 195, §5; am L 1996, c 28, §4]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-307 Disclosure standards.

§431:10A-307 Disclosure standards.
(a) In order to provide for full and fair disclosure in the sale of medicare supplement policies, no medicare supplement policy or certificate shall be delivered or issued for delivery in this State unless an outline of coverage is delivered to the applicant at or prior to the time application is made.
(b) The commissioner shall prescribe the format and content of the outline of coverage required by subsection (a). For the purposes of this section, format means style, arrangement and overall appearance, including such items as the size, color, prominence of type, and the arrangement of text and captions. The outline of coverage shall include:
(1) A description of the principal benefits and coverage provided in the policy;
(2) A statement of the renewal provisions including any reservation by the issuer of a right to change premiums; and disclosure of the existence of any automatic renewal premium increases based on the policyholder's age; and
(3) A statement that the outline of coverage is a summary of the policy issued or applied for and that the policy should be consulted to determine governing contractual provisions.
(c) The commissioner may prescribe by rule a standard form and contents of an informational brochure for persons eligible for medicare which is intended to improve the buyer's ability to select the most appropriate coverage and improve the buyer's understanding of medicare. Except in the case of direct response insurance policies, the commissioner may require by rule that the informational brochure be provided to any prospective insureds eligible for medicare concurrently with delivery of the outline of coverage. With respect to direct response insurance policies, the commissioner may require by rule that the prescribed brochure be provided upon request to any prospective insureds eligible for medicare, but in no event later than the time of policy delivery.
(d) The commissioner may adopt reasonable rules for captions or notice requirements, determined to be in the public interest and designed to inform prospective insureds that particular insurance coverages are not medicare supplement coverages, for all accident and health or sickness insurance policies sold to persons eligible for medicare, other than:
(1) Medicare supplement policies; or
(2) Disability income policies.
(e) The commissioner may adopt reasonable rules to govern the full and fair disclosure of information in connection with the replacement of accident and health or sickness insurance policies, subscriber contracts, or certificates by persons eligible for medicare. [L 1987, c 347, pt of §2; am L 1990, c 84, §6; am L 1992, c 195, §6; am L 1996, c 28, §5; am L 2002, c 155, §64]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-308 Notice of free examination.

§431:10A-308 Notice of free examination.
Medicare supplement policies and certificates shall have a notice prominently printed on the first page of the policy or certificate or attached thereto stating in substance that the applicant shall have the right to return the policy or certificate within thirty days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the applicant is not satisfied for any reason. Any refund made pursuant to this section shall be paid directly to the applicant by the issuer in a timely manner. [L 1987, c 347, pt of §2; am L 1989, c 195, §29; am L 1990, c 84, §7; am L 1992, c 195, §7]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-309 Filings; approval of forms.

§431:10A-309 Filings; approval of forms.
(a) No medicare supplement policy or certificate shall be delivered or issued for delivery in this State after the date specified in rules adopted by the commissioner unless the form of the policy or certificate is approved in accordance with this section.
(b) Every issuer providing medicare supplement insurance benefits to a resident of this State shall file with the commissioner a copy of the policy and any certificate used in this State, including copies of any riders or endorsements of applications which may be attached to or made a part of the policy. The commissioner may require a certification from the issuer that, to the best of the certifier's knowledge and belief, the filing complies with the minimum standards established in the rules and all applicable Hawaii laws and rules.
(c) Every issuer providing medicare supplement policies or certificates in this State shall file annually its rates, rating schedule, and supporting documentation demonstrating that it is in compliance with the applicable loss ratio standards of this State. The commissioner may require the issuer to submit a certification by a qualified actuary that the premium rates, to the best of the actuary's knowledge and belief, are in accordance with the loss ratio standards adopted by rule.
(d) The commissioner may disapprove any policy or certificate or withdraw approval of a previously approved policy or certificate if the commissioner finds that:
(1) It is not in accordance with applicable laws and rules in any respect;
(2) It is or it contains provisions which are misleading, deceptive, inconsistent, or ambiguous; or
(3) The benefits are unreasonable in relation to the premium charge.
(e) A policy or certificate shall be deemed approved if:
(1) It is in accordance with all applicable laws and rules;
(2) It has not been disapproved earlier than sixty-one days after the date of filing;
(3) It fully meets all filing requirements; and
(4) It is received by the commissioner.
(f) The commissioner shall promptly give written notice to the issuer of the commissioner's approval of a policy or certificate or, if a policy or certificate is disapproved or approval is withdrawn, of such disapproval or withdrawal together with the reasons for it and of the procedure by which the issuer may request and be granted a hearing on the merits of such action.
(g) The commissioner by rule may establish requirements and procedures for medicare supplement filings. [L 1987, c 347, pt of §2; am L 1990, c 84, §8; am L 1992, c 195, §8; am L 2004, c 122, §35]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-310 Filing requirements for advertising.

§431:10A-310 Filing requirements for advertising.
(a) Every issuer of medicare supplement insurance policies or certificates in this State shall file a copy of any medicare supplement advertisement intended for use in this State whether through written, radio, or television medium to the commissioner for review. The commissioner may require a certification from the entity that to the best of the certifier's knowledge and belief the advertisement complies with the provisions of this chapter and all applicable rules.
(b) If the commissioner finds the advertisement to be in violation of any provision of this chapter or any rule, the commissioner shall order the issuer to cease and desist use of the advertisement pursuant to section 431:2-203.
(c) In conjunction with a cease and desist order issued pursuant to subsection (b), the commissioner may order the issuer to refund to the insured the premium paid for the medicare supplement policy. Any refund of an amount paid by the insured for the medicare supplement insurance shall be paid within fifteen days to the person entitled thereto; provided that by rule the commissioner may prescribe an amount below which no refund need be made. [L 1989, c 195, §3; am L 1990, c 84, §9; am L 1992, c 195, §9; am L 2004, c 122, §36]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-311 Penalties.

§431:10A-311 Penalties.
In addition to any other applicable penalties for violations of this chapter, pursuant to section 431:2-203, the commissioner may require issuers violating any provision of this part or rules adopted pursuant to this part to cease marketing or selling any medicare supplement policy in this State which is related directly or indirectly to a violation or may require the issuer to take actions necessary to comply with the provisions of this part, or both. [L 1989, c 195, §4; am L 1992, c 195, §10]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-312 Severability.

§431:10A-312 Severability.
If any provision of this part or the application thereof to any person or circumstances is for any reason held to be invalid, the remainder of the part and the application of such provision to other persons or circumstances shall not be affected thereby. [L 1989, c 195, §5]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-401 Purpose.

Attorney General Opinions
Section 431:10A-601 applied to all parts of article 10A if the category of policy under consideration included family coverage, as defined in §431:10A-103. Att. Gen. Op. 97-10.
§431:10A-401 Purpose.
It is the purpose of this part to provide a means of more adequately meeting the needs of persons who are sixty-five years of age or older and their spouses for insurance coverage against financial loss from accident or disease through the combined resources and experience of a number of insurers; to make possible the fullest extension of such coverage by encouraging insurers to combine their resources and experience and to exercise their collective efforts in the development and offering of policies of such insurance to all such applicants at costs lower than those generally available through individual insurers; and to regulate the joint activities herein authorized in accordance with the intent of Congress as expressed in the Act of Congress of March 9, 1945 (Public Law 15, 79th Congress), as amended. [L 1987, c 347, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-402 Definitions.

§431:10A-402 Definitions.
Unless the context otherwise requires, for the purposes of this part:
(1) Association means a voluntary unincorporated association formed for the purpose of enabling cooperative action to provide accident and health or sickness insurance as defined in section 431:1-205, in accordance with this part in this or any other state having legislation enabling the issuance of insurance of the type provided in this part.
(2) Insurer means any insurance company authorized to transact accident and health or sickness insurance in this State.
(3) Extended health insurance means hospital, surgical, and medical expense insurance provided by a policy issued as provided by this part. [L 1987, c 347, pt of §2; am L 2002, c 155, §65]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-403 Association of insurers; policyholder; policy.

§431:10A-403 Association of insurers; policyholder; policy.
(a) Any insurer may join with one or more other insurers to plan, develop, underwrite, offer and provide to any person who is sixty-five years of age or older and to the spouse of such person, extended health insurance against financial loss from accident or disease, or both. The insurance may be offered, issued and administered jointly by two or more insurers by a group policy issued to a policyholder through an association formed for the purpose of offering, selling, issuing and administering such insurance.
(b) The policyholder may be an association, a trustee, or any other person. A master group policy issued to an association or to a trustee or any person appointed by an association for the purpose of providing the insurances described in this part shall be another form of group disability insurance.
Any form of policy approved by the commissioner for an association shall be offered throughout the State to all persons sixty-five and older and their spouses, and the coverage of any person insured under such a form of policy shall not be cancellable except for nonpayment of premiums unless the coverage of all persons insured under such form of policy is also cancelled.
(c) Any such policy may provide, among other things, that the benefits payable under the policy are subject to reduction if the individual insured has any other coverage providing hospital, surgical or medical benefits whether on an indemnity basis or a provision of service basis resulting in such insured being eligible for more than one hundred per cent of covered expenses which the insured is required to pay. Any insurer issuing individual policies providing extended hospital, surgical or medical benefits to persons sixty-five years of age and older and their spouses may also use such a policy provision. [L 1987, c 347, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-404 Persons authorized to transact insurance.

§431:10A-404 Persons authorized to transact insurance.
Notwithstanding the provisions of article 9A, any person licensed to transact accident and health or sickness insurance as a producer may transact extended health insurance and may be paid a commission in accordance with commission schedules filed with the commissioner as required by section 431:10A-406. [L 1987, c 347, pt of §2; am L 2001, c 216, §16; am L 2002, c 155, §66; am L 2003, c 212, §79]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-404.5 Genetic information nondiscrimination in extended health insurance coverage.

§431:10A-404.5 Genetic information nondiscrimination in extended health insurance coverage.
(a) No insurer may:
(1) Use an individual's or a family member's genetic information, or request for genetic services, to deny or limit any coverage or establish eligibility, continuation, enrollment, or premium payments;
(2) Request or require collection or disclosure of an individual's or a family member's genetic information; or
(3) Disclose an individual's or a family member's genetic information without the written consent of the person affected, the person's legal guardian, or a person with power of attorney for health care for the person affected. This consent shall be required for each disclosure and shall include the name of each person or organization to whom the disclosure will be made.
(b) As used in this section:
"Family member" means, with respect to the individual, another individual related by blood to that individual.
"Genetic information" means information about genes, gene products, hereditary susceptibility to disease, or inherited characteristics that may derive from the individual or family member.
"Genetic services" means health services to obtain, assess, or interpret genetic information for diagnosis, therapy, or genetic counseling.
(c) This section shall not apply to any action taken in connection with policies of life insurance, disability income insurance, and long-term care insurance delivered or issued for delivery in this State. [L 2002, c 217, §2]
Law Journals and Reviews
Privacy and Genetics: Protecting Genetic Test Results in Hawai €˜i. 25 UH L. Rev. 449 (2003).
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-405 Association; powers, process; examination.

§431:10A-405 Association; powers, process; examination.
Any association formed for the purposes of this part may hold title to property, may enter into contracts, and may limit the liability of its members to their respective pro rata shares of the liability of such association. Any such association may sue and be sued in its associate name and for such purpose only shall be treated as a domestic corporation. Service of process against the association, made upon a managing agent, any of its members or any agent authorized by appointment to receive service of process, shall have the same force and effect as if the service had been made upon all members of the association. The association's books and records shall also be subject to examination under the provisions of article 2, either separately or concurrently with examination of any of its member insurers. [L 1987, c 347, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-406 Forms; rates; approval.

§431:10A-406 Forms; rates; approval.
(a) The forms of the policies, applications, certificates, or other evidence of insurance coverage, commission schedules, and applicable premium rates relating thereto shall be filed with the commissioner.
(b) No policy, contract, certificate, or other evidence of insurance, application, or other form shall be sold, issued, or used and no endorsement shall be attached to or printed or stamped thereon unless its form has been approved by the commissioner or thirty days have expired after such filing without written notice from the commissioner of disapproval. The commissioner shall disapprove the forms for such insurance if the commissioner finds:
(1) That they are unjust, inequitable, misleading, or deceptive; or
(2) That the rates are by reasonable assumptions excessive in relation to the benefits provided.
In determining whether the rates by reasonable assumptions are excessive in relation to the benefits provided, the commissioner shall give due consideration to past and prospective claim experience, within and outside this State, and to fluctuations in such claim experience, to a reasonable risk charge, to contribution to surplus and contingency funds, to past and prospective expenses, both within and outside this State, and to all other relevant factors within and outside this State, including any differing operating methods of the insurers joining in the issue of the policy. In exercising the powers conferred by this part, the commissioner shall not be bound by any other requirement of this code with respect to standard provisions to be included in accident and health or sickness policies or forms.
(c) After hearing, upon written notice, the commissioner may withdraw an approval previously given if the commissioner is of the opinion that an original submission would have been disapproved. Such withdrawal of approval shall be effective not less than ninety days after the giving of notice of withdrawal. [L 1987, c 347, pt of §2; am L 2003, c 212, §80]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-407 Duplication of benefits; adjustment.

§431:10A-407 Duplication of benefits; adjustment.
If and when a program of hospital, surgical, and medical benefits is enacted by the federal government or by the State, the extended health insurance benefits provided by policies issued under this section shall be adjusted to avoid any duplication of benefits offered by the federal or state programs. The premium rates applicable thereto shall be adjusted to conform with the adjusted benefits. [L 1987, c 347, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-408 Annual report filed by association.

§431:10A-408 Annual report filed by association.
The association shall submit an annual report to the commissioner which shall become public information and shall include the following:
(1) The number of persons insured;
(2) The names of the insurers participating in the association with respect to insurance offered under this part;
(3) The calendar year experience applicable to such insurance offered under this part. Item (3) shall include:
(A) Premiums earned,
(B) Claims paid during the calendar year,
(C) The amount of claims reserve established,
(D) Administrative expenses,
(E) Commissions,
(F) Promotional expenses,
(G) Taxes,
(H) Contingency reserve,
(I) Other expenses, and
(J) Profit and loss for the year.
The commissioner shall require the association to provide any and all information concerning the operations of the association deemed relevant by the commissioner for inclusion in the report. [L 1987, c 347, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-409 Articles of association; agent, membership list; deception.

§431:10A-409 Articles of association; agent, membership list; deception.
(a) Any association formed in accordance with this part shall file the following with the commissioner:
(1) The articles of association;
(2) All amendments and supplements to the articles of association;
(3) A designation in writing of a resident of this State as agent for the service of process; and
(4) A list of insurers who are members of the association and all supplements thereto.
(b) The name of any association or any advertising or promotional material used in connection with extended health insurance to be sold, offered or issued pursuant to this section shall not be such as to mislead or deceive the public. [L 1987, c 347, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-410 Violation of other laws.

§431:10A-410 Violation of other laws.
No act done, action taken, or agreement made pursuant to the authority conferred by this part shall constitute a violation of or grounds for prosecution or civil proceedings under any other law of this State which does not specifically refer to insurance. [L 1987, c 347, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-602 Federally funded programs; exemption.

§431:10A-602 Federally funded programs; exemption.
Requirements relating to mandated coverages shall not be applicable to any insurer offering accident and health or sickness 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 insurer's business under the federally funded program. [L 1999, c 159, §1; am L 2003, c 212, §81]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-603 Self-employed persons, exemption.

§431:10A-603 Self-employed persons, exemption.
The requirements of this article related to mandated coverages for persons insured under accident and health or sickness policies shall not apply to accident and health or sickness policies for self-employed persons in this State; provided that this exemption shall apply only to those portions of the accident and health or sickness policies that cover self-employed persons in this State and individuals included in the self-employed person's family coverage. [L 2004, c 122, §1; am L 2006, c 154, §38]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-604 Bona fide trade associations.

§431:10A-604 Bona fide trade associations.
(a) At the option of a bona fide trade association, or its designated agent, an insurer that sells health insurance to the bona fide trade association shall treat the bona fide trade association and its members as a group for the purpose of issuing group disability insurance; provided that:
(1) The bona fide trade association shall have been formed for purposes other than obtaining insurance;
(2) The insurer shall be prohibited from restricting, in any manner, the number or types of health plans issued by another insurance entity that the bona fide trade association may offer to its members, including but not limited to such restrictions as clauses that reduce competition between insurers or clauses that require a bona fide trade association to allow an insurer to match the price or terms offered by another insurer; and
(3) Each member of the bona fide trade association shall not be required to be insured under the group policy;
and provided further that this section shall be inapplicable if less than two persons from the bona fide trade association seek to be insured under the group policy.
(b) As used in this section:
"Bona fide trade association" means an association of persons organized to promote common interests and comprised of persons engaged in a business, trade, or profession that:
(1) Has been actively in existence for five years;
(2) Has been formed and maintained in good faith for purposes other than obtaining insurance;
(3) Does not condition membership in the association on any health status related factor pertaining to an individual (including an employee of an employer or a dependent of an employee);
(4) Makes health insurance coverage offered through the association available to all members regardless of any health status related factor pertaining to such members (or individuals eligible for coverage through a member);
(5) Does not make health insurance coverage offered through the association available other than in connection with a member of the association; and
(6) Meets such additional requirements as may be imposed under state law. [L 2004, c 118, § §1, 5; am L 2006, c 41, §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-605 Short-term, limited-duration health insurance.

§431:10A-605 Short-term, limited-duration health insurance.
(a) No insurer shall issue, renew, or re-enroll an individual in a short-term, limited-duration health insurance policy or contract if the individual was eligible to purchase health insurance through the federal health insurance marketplace during an open enrollment period, as provided by title 45 Code of Federal Regulations section 155.410, or a special enrollment period, as provided by title 45 Code of Federal Regulations section 155.420, in the previous calendar year; provided that any short-term, limited-duration health insurance coverage policy or contract that is delivered or issued for delivery in the State shall have an expiration date in the contract that is less than ninety-one days.
(b) For the purposes of this section:
"Renew or re-enroll" means the issuance of the same or a new short-term, limited-duration health insurance policy or contract to an individual who has been covered by a short-term, limited-duration health insurance policy or contract at any time within the previous calendar year.
"Short-term, limited-duration health insurance" means health insurance coverage provided to an individual under a policy or contract offered by a licensed insurer, regardless of the situs of the delivery of the policy or contract, that has a specified, short-term limited duration of less than ninety-one days and does not meet all of the requirements otherwise applicable to individual health insurance. [L 2018, c 192, §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-606 Medication synchronization; proration; dispensing fees.

§431:10A-606
Medication synchronization; proration; dispensing fees.
(a) Each individual or group policy of accident and health or sickness insurance 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 insured patient requests or agrees to less than a thirty-day supply.
(b) For the purposes of medication synchronization under this section, the insurer 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 insured 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 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 under this section.
(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 insured 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, §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-607 Limited benefit health insurance

§431:10A-607 Limited benefit health insurance
. (a) Except as provided in subsection (b) or elsewhere in this article, when used in this article, the terms "accident insurance", "health insurance", or "sickness insurance" shall not include an accident-only; specified disease; hospital indemnity; long-term care; disability; dental; vision; medicare supplement; short-term, limited-duration health insurance; or other limited benefit health insurance contract that pays benefits directly to the insured or the insured's assigns and in which the amount of the benefit paid is not based upon the actual costs incurred by the insured.
(b) When used in sections 431:10A-104, 431:10A-105, 431:10A-106, 431:10A-107, 431:10A-108, 431:10A-109, 431:10A-110, 431:10A-111, 431:10A-112, 431:10A-113, 431:10A-114, 431:10A-117, 431:10A-118, 431:10A-201, 431:10A-202, 431:10A-203, 431:10A-204, 431:10A-205, 431:10A-208, 431:10A-601, 431:10A-602, 431:10A-603, and 431:10A-604, except as otherwise provided, the terms "accident insurance", "accident and health or sickness insurance", "health insurance", or "sickness insurance" shall include an accident-only; specified disease; hospital indemnity; long-term care; disability; dental; vision; medicare supplement; short-term, limited-duration health insurance; or other limited benefit health insurance contract regardless of the manner in which benefits are paid; provided that if any of the requirements in the foregoing sections as applied to long-term care insurance conflict with article 10H, the provisions of article 10H shall govern and control. [L 2019, c 70, §3]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10B-101 Purpose.

§431:10B-101 Purpose.
The purpose of this article is to promote the public welfare by regulating credit life insurance and credit disability insurance. Nothing in this article is intended to prohibit or discourage reasonable competition. The provisions of this article shall be liberally construed. [L 1987, c 347, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10B-102 Scope

§431:10B-102 Scope
. All life insurance and all accident and health or sickness insurance in connection with loans or other credit transactions shall be subject to this article, except such insurance in connection with a loan or other credit transaction of more than ten years' duration; nor shall insurance be subject to this article where the issuance of such insurance is an isolated transaction on the part of the insurer not related to an agreement or a plan for insuring debtors of the creditor. Nothing in this article shall be construed to relieve any person from compliance with any other applicable law. [L 1987, c 347, pt of §2; am L 2002, c 155, §67]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10B-103 Definitions.

§431:10B-103 Definitions.
For the purpose of this article:
"Credit disability insurance" means insurance on a debtor to provide indemnity for payments becoming due on a specific loan or other credit transaction while the debtor is disabled as defined in the policy.
"Credit life insurance" means insurance on the life of a debtor pursuant to or in connection with a specific loan or other credit transaction.
"Creditor" means the lender of money, or seller or lessor of goods, services, property, rights, or privileges, for which payment is arranged through a credit transaction, or any successor to the right, title, or interest of any lender, seller, or lessor, and an affiliate, associate, or subsidiary of any of them or any director, officer, or employee of any of them, or any other person in any way associated with any of them.
"Debtor" means a borrower of money or a purchaser or lessee of goods, services, property, rights, or privileges for which payment is arranged through a credit transaction.
"Indebtedness" means the total amount payable by a debtor to a creditor in connection with a loan or other credit transaction. [L 1987, c 347, pt of §2; am L 2018, c 18, §26]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10B-104 Forms of credit life insurance and credit disability insurance

§431:10B-104 Forms of credit life insurance and credit disability insurance
. Credit life insurance and credit disability insurance shall be issued only in the following forms:
(1) Individual policies of life insurance issued to debtors on the term plan;
(2) Individual policies of accident and health or sickness insurance issued to debtors on a term plan or disability benefit provisions in individual policies of credit life insurance;
(3) Group policies of life insurance issued to creditors pursuant to section 431:10D-203 providing insurance upon the lives of debtors on the term plan; and
(4) Group policies of accident and health or sickness insurance issued to creditors on a term plan insuring debtors or disability benefit provisions in group credit life insurance policies to provide such coverage. [L 1987, c 347, pt of §2; am L 2003, c 212, §82]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10B-105 Amount of credit life insurance and credit disability insurance.

§431:10B-105
Amount of credit life insurance and credit disability insurance.
(a) Credit life insurance.
(1) The initial amount of credit life insurance shall not exceed the total amount repayable under the contract of indebtedness and, where an indebtedness is repayable in substantially equal installments, the amount of insurance shall at no time exceed the scheduled or actual amount of unpaid indebtedness, whichever is greater; except that if the sole purpose of the loan is to provide future advances to the debtor to meet education or education related expenses of the debtor, the debtor's spouse, children or other dependents, the amount of insurance may equal, but may not exceed, the total amount of the described expenses forecast at the time of entry into the loan agreement with the creditor, less the amount of all repayments by the debtor. In the case of revolving loan or revolving charge accounts, the insurance shall at no time exceed the unpaid indebtedness.
(2) Notwithstanding the provisions of subsection (a)(1), insurance on agricultural credit transaction commitments not exceeding one year in duration may be written up to the amount of the loan commitment, on a nondecreasing or level term plan.
(b) Credit disability insurance. The total amount of periodic indemnity payable by credit disability insurance in the event of disability, as defined in the policy, shall not exceed the aggregate of the periodic scheduled unpaid installments of the indebtedness. The amount of each periodic indemnity payment shall not exceed the original indebtedness divided by the number of periodic installments. [L 1987, c 347, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10B-106 Term of credit life and credit disability insurance.

§431:10B-106 Term of credit life and credit disability insurance.
The term of any credit life insurance or credit disability insurance shall, subject to acceptance by the insurer, commence on the date when the debtor becomes obligated to the creditor; except that where a group policy provides coverage with respect to existing obligations, the insurance on a debtor with respect to the indebtedness shall commence on the effective date of the policy. Where evidence of insurability is required and the evidence is furnished more than thirty days after the date when the debtor becomes obligated to the creditor, the term of the insurance may commence on the date on which the insurer determines the evidence to be satisfactory, and in such event, there shall be an appropriate refund or adjustment of any charge to the debtor for insurance. The term of such insurance shall not extend more than fifteen days beyond the scheduled maturity date of the indebtedness except when extended without additional cost to the debtor. If the indebtedness is discharged due to renewal or refinancing prior to the scheduled maturity date, the insurance in force shall be terminated before any new insurance may be issued in connection with the renewed or refinanced indebtedness. In all cases of termination prior to scheduled maturity, a refund shall be paid or credited as provided in section 431:10B-109. [L 1987, c 347, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10B-109 Premiums and refunds.

§431:10B-109 Premiums and refunds.
(a) Any insurer may revise its schedules of premium rates from time to time, and shall file the revised schedules for approval with the commissioner. No insurer shall issue any credit life insurance policy or credit disability insurance policy for which the premium rate exceeds that determined by the schedules of the insurer as then on file with and approved by the commissioner.
(b) Each individual policy, group certificate, or notice of proposed insurance shall provide that in the event of termination of the insurance prior to the scheduled maturity date of the indebtedness, any refund of an amount paid by the debtor for the insurance shall be paid or credited promptly to the person entitled thereto; provided that the commissioner, by rules and regulations, shall prescribe a minimum refund and no refund which would be less than the minimum need be made. The formula to be used in computing the refund shall be filed with and approved by the commissioner.
(c) If a creditor requires a debtor to make any payment for credit life insurance or credit disability insurance and an individual policy or group certificate of insurance is not issued, the creditor shall immediately give written notice to the debtor and shall promptly make an appropriate credit to the next payment due on the account.
(d) The amount charged to a debtor for any credit life or credit disability insurance shall not exceed the premium charged by the insurer, as computed at the time the charge to the debtor is determined.
(e) Nothing in this article shall be construed to authorize any payments for insurance now prohibited under any statute, or rule thereunder, governing credit transactions. [L 1987, c 347, pt of §2]