reglab/statecodes huggingface dataset:
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-29 Prohibition on rescissions of coverage.

§432D-29
Prohibition on rescissions of coverage.
(a) Notwithstanding sections 431:10-226.5 and 431:10A-106 to the contrary, a health maintenance organization shall not rescind coverage under a health benefit plan with respect to an individual, including a group to which the individual belongs or family coverage in which the individual is included, after the individual is covered under the plan, unless:
(1) The individual or a person seeking coverage on behalf of the individual performs an act, practice, or omission that constitutes fraud;
(2) The individual makes an intentional misrepresentation of material fact as prohibited by the terms of the plan or coverage; or
(3) The individual fails to timely pay required premiums or contributions toward the cost of coverage; provided that the rescission is in compliance with federal regulations.
As used in this subsection, "a person seeking coverage on behalf of the individual" shall not include an insurance producer or employee or authorized representative of the health carrier.
(b) A health maintenance organization shall provide at least thirty days advance written notice to each plan enrollee or, for individual health insurance coverage, to each primary subscriber, who would be affected by the proposed rescission of coverage before coverage under the plan may be rescinded in accordance with subsection (a) regardless of whether, in the case of group health insurance coverage, the rescission applies to the entire group or only to an individual within the group.
(c) This section applies regardless of any applicable contestability period. [L 2014, c 186, §3]
2023 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]
2023 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]
2023 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]
2023 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]
2023 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]
2023 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]
2023 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]
2023 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]
2023 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]
2023 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]
2023 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]
2023 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]
2023 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]
2023 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]
2023 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]
2023 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]
2023 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]
2023 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]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432E. Patients' Bill of Rights and Responsibilities Act › 432E-38 Approval of independent review organizations.

§432E-38 Approval of independent review organizations.
(a) An independent review organization shall be approved by the commissioner in order to be eligible to be assigned to conduct external reviews under this part.
(b) To be eligible for approval by the commissioner to conduct external reviews under this part an independent review organization shall:
(1) Submit an application on a form required by the commissioner and include all documentation and information necessary for the commissioner to determine if the independent review organization satisfies the minimum qualifications established under this part; and
(2) Except as otherwise provided in subsection (c), shall be accredited by a nationally-recognized private accrediting entity that the commissioner has determined has independent review organization accreditation standards that are equivalent to or exceed the minimum standards established by this section and section 432E-39.
(c) The commissioner may approve independent review organizations that are not accredited by a nationally-recognized private accrediting entity if there are no acceptable nationally-recognized private accrediting entities providing independent review organization accreditation.
(d) The commissioner may charge an application fee that the independent review organizations shall submit to the commissioner with an application for approval and re-approval.
(e) Approval pursuant to this section is effective for two years, unless the commissioner determines before its expiration that the independent review organization does not meet the minimum qualifications established under this part. If the commissioner determines that an independent review organization has lost its accreditation or no longer satisfies the minimum requirements of this part, the commissioner shall terminate the approval of the independent review organization and remove the independent review organization from the list of independent review organizations approved to conduct external reviews maintained by the commissioner.
(f) The commissioner shall maintain and periodically update a list of approved independent review organizations. [L 2011, c 230, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432E. Patients' Bill of Rights and Responsibilities Act › 432E-40 Hold harmless for independent review organizations.

§432E-40 Hold harmless for independent review organizations.
No independent review organization or clinical reviewer working on behalf of an independent review organization or an employee, agent, or contractor of an independent review organization shall be liable in damages to any person for any opinions rendered or acts or omissions performed within the scope of the organization's or person's duties under the law during or upon completion of an external review conducted pursuant to this part, unless the opinion was rendered or the act or omission was performed in bad faith or involved gross negligence. [L 2011, c 230, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432E. Patients' Bill of Rights and Responsibilities Act › 432E-41 External review reporting requirements.

§432E-41 External review reporting requirements.
(a) An independent review organization assigned pursuant to this part to conduct an external review shall maintain written records in the aggregate by state and by health carrier on all requests for external review for which it conducted an external review during a calendar year and upon request shall submit a report to the commissioner, as required under subsection (b).
(b) Each independent review organization required to maintain written records on all requests for external review pursuant to subsection (a) for which it was assigned to conduct an external review shall submit to the commissioner, upon request, a report in the format specified by the commissioner. The report shall include in the aggregate by state, and for each health carrier:
(1) The total number of requests for external review;
(2) The number of requests for external review resolved and, of those resolved, the number resolved upholding the adverse action and the number resolved reversing the adverse action;
(3) The average length of time for resolution;
(4) The summary of the types of coverages or cases for which an external review was sought, as provided in the format required by the commissioner;
(5) The number of external reviews that were terminated as the result of a reconsideration by the health carrier of its adverse action after the receipt of additional information from the enrollee or the enrollee's appointed representative; and
(6) Any other information the commissioner may request or require.
The independent review organization shall retain the written records required pursuant to this subsection for at least three years.
(c) Each health carrier shall maintain written records in the aggregate, by state and for each type of health benefit plan offered by the health carrier on all requests for external review that the health carrier receives notice of from the commissioner pursuant to this part.
Each health carrier required to maintain written records on all requests for external review shall submit to the commissioner, upon request, a report in the format specified by the commissioner that includes in the aggregate, by state, and by type of health benefit plan:
(1) The total number of requests for external review;
(2) From the total number of requests for external review reported, the number of requests determined eligible for a full external review; and
(3) Any other information the commissioner may request or require.
The health carrier shall retain the written records required pursuant to this subsection for at least three years. [L 2011, c 230, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432E. Patients' Bill of Rights and Responsibilities Act › 432E-42 Funding of external review.

§432E-42 Funding of external review.
The health carrier against which a request for a standard external review or an expedited external review is filed shall pay the cost of the independent review organization for conducting the external review. There shall be no recourse against the commissioner for the cost of conducting the external review and the selection of an independent review organization shall not be subject to chapter 103D; provided that the commissioner may initially approve up to three independent review organizations to serve beginning on the effective date of this part until the initial procurement process is completed; provided further that in any year in which procurement subject to chapter 103D does not produce at least three independent review organizations eligible for selection under section 432E-39, the commissioner may approve up to three independent review organizations notwithstanding the requirements of chapter 103D. [L 2011, c 230, pt of §2]
Note
For "effective date of this part", referred to in second sentence, see L 2011, c 230, §17.
2023 Hawaii Revised Statutes › Title 24. Insurance › 432E. Patients' Bill of Rights and Responsibilities Act › 432E-44 Rules.

§432E-44 Rules.
The insurance commissioner shall adopt rules pursuant to chapter 91 to effectuate the purpose of this part including requirements for forms to request external review and expedited external review, to request approval by independent review organizations, and for disclosure of conflicts of interest by enrollees and health carriers. [L 2011, c 230, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432G. Dental Insurers › 432G-3 Fiduciary responsibilities.

§432G-3 Fiduciary responsibilities.
(a) Any director, officer, employee, or partner of a dental insurer who receives, collects, disburses, or invests funds in connection with the activities of an organization shall be responsible for the funds in a fiduciary relationship to the organization.
(b) A dental insurer shall maintain in force a fidelity bond or fidelity insurance on employees, officers, directors, and partners subject to subsection (a) in an amount not less than $250,000 for each dental insurer or a maximum of $5,000,000 in aggregate maintained on behalf of dental insurers owned by a common parent corporation, or a sum as may be prescribed by the commissioner. [L 2013, c 191, pt of §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432G. Dental Insurers › 432G-4 Annual reports.

§432G-4 Annual reports.
(a) Each dental insurer shall file with the commissioner:
(1) An audit, by an independent certified public accountant or an accounting firm designated by the dental insurer of the financial statements, reporting the financial condition and results of operations of the dental insurer, annually on or before June 1, or a later date as the commissioner upon request or for cause may specify. The dental insurer, on an annual basis and prior to the commencement of the audit, shall notify the commissioner in writing of the name and address of the person or firm retained to conduct the annual audit. The commissioner may disapprove the dental insurer's designation within fifteen days of receipt of the dental insurer's notice, and the dental insurer shall be required to designate another independent certified public accountant or accounting firm;
(2) A list of the providers who have executed a contract that complies with section 432G-6(d), annually on or before March 1; and
(3) A description of the available grievance procedures, the total number of grievances handled through those procedures, a compilation of the causes underlying those grievances, and a summary of the final disposition of those grievances, annually on or before March 1.
(b) The commissioner may require additional reports as are deemed necessary and appropriate to enable the commissioner to carry out the commissioner's duties under this chapter.
(c) Any dental insurer failing or refusing to submit any of the documents required under this section shall be liable for a penalty in an amount not less than $100 and not more than $500 for each day of delinquency. Penalties collected pursuant to this section shall be deposited into the compliance resolution fund. [L 2013, c 191, pt of §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432G. Dental Insurers › 432G-5 Information to subscribers.

§432G-5 Information to subscribers.
(a) The dental insurer shall provide to its subscribers a list of providers and participating providers, upon enrollment and reenrollment.
(b) Every dental insurer shall provide to its subscribers notice of any material change in the operation of the organization that will affect them directly within thirty days of the material change.
(c) The dental insurer shall provide to subscribers information on how dental care services may be obtained, where additional information on access to dental care services may be obtained, a description of the internal grievance procedures, and a telephone number for a subscriber to contact the dental insurer at no cost to the subscriber.
(d) For the purpose of this section, "material change" means any major change in provider or participating provider agreements. [L 2013, c 191, pt of §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432G. Dental Insurers › 432G-7 Uncovered expenditures insolvency deposit.

§432G-7 Uncovered expenditures insolvency deposit.
(a) If, at any time, uncovered expenditures exceed ten per cent of total dental care expenditures, a dental insurer shall place with the commissioner or with any organization or trustee acceptable to the commissioner through which a custodial or controlled account is maintained, an uncovered expenditures insolvency deposit consisting of cash or securities that are acceptable to the commissioner. Such deposit shall have, at all times, a fair market value in an amount of one-hundred-twenty per cent of the dental insurer's outstanding liability for uncovered expenditures for enrollees in this State, including incurred but not reported claims, and shall be calculated as of the first day of the month and maintained for the remainder of the month. If a dental insurer is not otherwise required to file a quarterly report, it shall file a report within forty-five days of the end of the calendar quarter with information sufficient to demonstrate compliance with this section.
(b) The deposit required under this section is in addition to the deposit required under section 432G-6 and is an asset of the dental insurer in the determination of net worth. All income from the deposits or trust accounts subject to this section shall be an asset of the dental insurer and may be withdrawn from the deposit or trust account quarterly with the approval of the commissioner.
(c) A dental insurer that has made a deposit may withdraw that deposit or any part of the deposit if:
(1) A substitute deposit of cash or securities of equal amount and value is made;
(2) The fair market value exceeds the amount of the required deposit; or
(3) The required deposit under subsection (a) is reduced or eliminated.
Deposits, substitutions, or withdrawals may be made only with the prior written approval of the commissioner.
(d) The deposit required under this section shall be held in trust and shall be used only as provided in this section. The commissioner may use the deposit of an insolvent dental insurer for administrative costs associated with administering the deposit and payment of claims of enrollees of this State for uncovered expenditures in this State. Claims for uncovered expenditures shall be paid on a pro rata basis based on assets available to pay such ultimate liability for incurred expenditures. Partial distribution may be made pending final distribution. Any amount of the deposit remaining shall be paid into the liquidation or receivership of the dental insurer.
(e) The commissioner may prescribe the time, manner, and form for filing claims under subsection (d).
(f) The commissioner may require dental insurers to file annual, quarterly, or more frequent reports as the commissioner deems necessary to demonstrate compliance with this section. The commissioner may require that the reports include liability for uncovered expenditures as well as an audit opinion. [L 2013, c 191, pt of §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432G. Dental Insurers › 432G-8 Reserve credit for reinsurance.

§432G-8 Reserve credit for reinsurance.
Any dental insurer that takes credit for reserves on risks ceded to a reinsurer shall be subject to provisions of article 4A of chapter 431. [L 2013, c 191, pt of §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432G. Dental Insurers › 432G-9 Replacement coverage.

§432G-9 Replacement coverage.
(a) Any carrier providing replacement coverage with respect to group dental benefits within a period of sixty days from the date of discontinuance of a prior dental insurer contract or policy providing such dental benefits shall immediately cover all enrollees who were validly covered under the previous dental insurer contract or policy at the date of discontinuance and who would otherwise be eligible for coverage under the succeeding carrier's contract, regardless of any provisions of the contract relating to active employment.
(b) Except to the extent benefits for the condition would have been reduced or excluded under the prior carrier's contract or policy, no provision in a succeeding carrier's contract of replacement coverage which would operate to reduce or exclude benefits on the basis that the condition giving rise to a claim for benefits preexisted the effective date of the succeeding carrier's contract shall be applied with respect to those enrollees validly covered under the prior carrier's contract or policy on the date of discontinuance. [L 2013, c 191, pt of §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432G. Dental Insurers › 432G-10 Powers of insurers and hospital and medical service corporations.

§432G-10 Powers of insurers and hospital and medical service corporations.
(a) An insurance company licensed in this State, or a hospital or medical service corporation authorized to do business in this State, either directly or through a subsidiary or affiliate, may organize and operate a dental insurer under the provisions of this chapter. Notwithstanding any other law to the contrary, any two or more insurance companies, hospital or medical service corporations, dental insurers, or subsidiaries or affiliates thereof, may jointly organize and operate a dental insurer. The business of insurance is deemed to include the providing of dental care services by a dental insurer owned or operated by an insurer or a subsidiary thereof.
(b) Notwithstanding any contrary provision of laws pertaining to insurance or hospital or medical service corporations under chapter 431, 432, or 432D, an insurer or a hospital or medical service corporation may contract with a dental insurer to provide insurance or similar protection against the cost of dental care services provided through dental insurers and to provide coverage in the event of the failure of the dental insurer to meet its obligations. The enrollees of a dental insurer constitute a group permitted under chapter 431, 432, or 432D. Among other things, under such contracts, the insurer or hospital or medical service corporation may make benefit payments to dental insurers for dental care services rendered by providers. [L 2013, c 191, pt of §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432G. Dental Insurers › 432G-11 Examinations.

§432G-11 Examinations.
(a) The commissioner may examine the affairs of any dental insurer or of any providers with whom a dental insurer has contracts, agreements, or other arrangements as often as is reasonably necessary for the protection of the interests of the people of this State.
(b) Every dental insurer and provider shall submit its books and records for examination and in every way facilitate the completion of an examination by the commissioner. In the event a dental insurer or a provider fails to comply with the directions of the commissioner, the commissioner may examine the affiliates of the dental insurer or provider to obtain the information. For the purpose of examinations, the commissioner may administer oaths to and examine the officers and agents of the dental insurer and the principals of providers concerning their business.
(c) The cost of examinations under this section shall be assessed against the dental insurer or provider being examined and shall be remitted to the commissioner for deposit into the compliance resolution fund.
(d) In lieu of the commissioner's own examination, the commissioner may accept the report of an examination made by the commissioner or the appropriate official of another state. [L 2013, c 191, pt of §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432G. Dental Insurers › 432G-12 Fees.

§432G-12 Fees.
(a) The commissioner shall collect, in advance, the following fees:
(1) Certificate of authority:
(A) Application for a certificate of authority: $900; and
(B) Issuance of certificate of authority: $600; and
(2) For all services subsequent to the issuance of a certificate of authority, including extension of the certificate of authority: $600 per year.
The commissioner may, upon showing of good cause, waive or modify, in whole or part, all fees in this subsection by order.
(b) No certificate of authority shall contain an expiration date, but all certificates of authority shall be extended by the commissioner from time to time in order to continue to be valid. When the commissioner issues or extends a certificate of authority, the commissioner shall determine the date prior to which the certificate of authority shall be extended and shall so notify the insurer in writing. This date is called the extension date. The extension date shall be any date not less than one year and not more than three years after date of issue or extension of the certificate of authority. If the insurer qualifies, its certificate of authority shall be extended. The commissioner shall provide each holder of a certificate of authority at least thirty days' advance written notice of the applicable extension date. If the fee for the extension of the certificate of authority is not paid before or on the extension date, a penalty shall be imposed in the amount of fifty per cent of the fee. The commissioner shall provide notice in writing of the delinquency of extension and the imposition of the authorized penalty. If the fee and the penalty are not paid within thirty days immediately following the date of the notice of delinquency, the commissioner may revoke the certificate of authority and may not reinstate the certificate of authority until the fee and penalty have been paid.
(c) All fees and penalties collected pursuant to this section shall be deposited into the compliance resolution fund. [L 2013, c 191, pt of §1; am L 2015, c 63, § §20, 21; am L 2021, c 110, §22]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432G. Dental Insurers › 432G-14 Summary orders and supervision.

§432G-14 Summary orders and supervision.
(a) Whenever the commissioner determines that the financial condition of any dental insurer is such that its continued operation might be hazardous to its enrollees, creditors, or the general public, or that it has violated any provision of this chapter, the commissioner, after notice and hearing, may order the dental insurer to take such action as may be reasonably necessary to rectify such condition or violation, including but not limited to:
(1) Reducing the total amount of present and potential liability for benefits by reinsurance or other method acceptable to the commissioner;
(2) Reducing the volume of new business being accepted;
(3) Reducing expenses by specified methods;
(4) Suspending or limiting the writing of new business for a period of time;
(5) Increasing the dental insurer's capital and surplus by contribution; or
(6) Taking any other steps as the commissioner may deem appropriate under the circumstances.
(b) For purposes of this section, the violation by a dental insurer of any law of this State to which the dental insurer is subject shall be deemed a violation of this chapter.
(c) The commissioner is authorized to set uniform standards and criteria for early warning that the continued operation of any dental insurer might be hazardous to its enrollees, creditors, or the general public, and to set standards for evaluating the financial condition of any dental insurer, which standards shall be consistent with the purposes expressed in subsection (a).
(d) The remedies and measures available to the commissioner under this section shall be in addition to, and not in lieu of, the remedies and measures available to the commissioner under the provisions of article 15 of chapter 431. [L 2013, c 191, pt of §1]