reglab/statecodes huggingface dataset:
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-104 Form of policy.

§431:10A-104 Form of policy.
(a) A policy of accident and health or sickness insurance shall neither be delivered nor issued for delivery to any person in this State unless:
(1) The entire monetary and other considerations are expressed in the policy;
(2) The time at which the insurance takes effect and terminates is expressed in or determinable from the policy;
(3) It purports to insure only one person, except that a policy may provide family coverage as defined in section 431:10A-103 or reciprocal beneficiary family coverage as defined in section 431:10A-601;
(4) The style, arrangement, and overall appearance of the policy give no undue prominence to any portion of the text, and unless every printed portion of the text of the policy and of any endorsements or attached papers is plainly printed in light-faced type of a style in general use, the size of which shall be uniform and not less than ten point with a lower case unspaced alphabet length not less than one hundred twenty point. The text shall include all printed matter except the name and address of the insurer, name or title of the policy, a brief description, if any, and captions and subcaptions;
(5) The exceptions and reductions of indemnity are set forth in the policy and, except for the required and optional provisions set forth in sections 431:10A-105 and 431:10A-106, are printed, at the insurer's option, either included with the benefit provision to which they apply, or under an appropriate caption such as exceptions, or exceptions and reductions; provided that if an exception or reduction specifically applies only to a particular benefit of the policy, a statement of the exception or reduction shall be included with the benefit provision to which it applies;
(6) Each policy form, including riders and endorsements, shall be identified by a form number in the lower left-hand corner of the first page; and
(7) It does not contain any provision purporting to make any portion of the charter, rules, constitution, or bylaws of the insurer a part of the policy unless such portion is set forth in full in the policy, except in the case of the incorporation of, or reference to, a statement of rates or classification of risks, or short-rate table filed with the commissioner.
(b) If any policy is issued by an insurer domiciled in this State for delivery to a person residing in a territory, district or another state of the United States, and if the official having responsibility for the administration of the insurance laws of such state, district or territory shall have advised the commissioner that the policy is not subject to approval or disapproval by the official, the commissioner may by ruling require that the policy meet the standards set forth in subsection (a) and in section 431:10A-105 and section 431:10A-106. [L 1987, c 347, pt of §2; am L 1997, c 383, §5; am L 2002, c 155, §51; am L 2004, c 122, §30]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-105.3 Association health plan policy; compliance with state law.

§431:10A-105.3 Association health plan policy; compliance with state law.
(a) Every association health plan policy issued in this State shall comply with all laws of this State, regardless of the domicile of the association that has issued the policy.
(b) For the purposes of this section, "association health plan policy" means a policy issued by a voluntary association of employers formed in this State or another state that is authorized to issue association health plans under the regulations of the United States Department of Labor. [L 2018, c 199, §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-105.5 Federal law compliance.

§431:10A-105.5 Federal law compliance.
An accident and health or sickness insurer shall comply with applicable federal law. The commissioner shall enforce the consumer protections and market reforms relating to insurance as set forth in the federal Patient Protection and Affordable Care Act, Public Law 111-148. [L 2011, c 15, §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-105.7 Required disclaimer.

§431:10A-105.7 Required disclaimer.
Any limited benefit policy, certificate, application, or sales brochure that provides coverage for accident and sickness, excluding specified disease, long-term care, disability income, accident-only, medicare supplement, dental, or vision shall disclose in a conspicuous manner and in not less than fourteen-point boldface type the following, or substantially similar, statement:
THIS IS NOT QUALIFYING HEALTH COVERAGE ("MINIMUM ESSENTIAL COVERAGE") THAT SATISFIES THE HEALTH COVERAGE REQUIREMENT OF THE AFFORDABLE CARE ACT. [L 2019, c 70, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-107 Inapplicable or inconsistent provisions.

§431:10A-107 Inapplicable or inconsistent provisions.
If any provision of section 431:10A-105 to section 431:10A-111 is in whole or in part inapplicable to or inconsistent with the coverage provided by a particular form of policy, the insurer shall omit from the policy any inapplicable provision or part of a provision, and shall modify any inconsistent provision or part of the provision to make the provision contained in the policy consistent with the coverage provided by the policy. An officer of the insurer shall certify conformity with the requirements of state statutes in accordance with this section. [L 1987, c 347, pt of §2; am L 2010, c 116, §1(17)]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-108 Order of certain policy provisions.

§431:10A-108 Order of certain policy provisions.
The provisions which are the subject of section 431:10A-105 and section 431:10A-106, or any corresponding provisions which are used in lieu thereof, shall be printed in the consecutive order of the provisions in such sections or, at the option of the insurer, any such provision may appear as a unit in any part of the policy, with other provisions to which it may be logically related; provided the resulting policy shall not be in whole or in part unintelligible, uncertain, ambiguous, abstruse, or likely to mislead a person to whom the policy is offered, delivered or issued. [L 1987, c 347, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-109 Third party ownership.

§431:10A-109 Third party ownership.
The word, insured, as used in this part, shall not be construed as preventing a person other than the insured with a proper insurable interest from making application for and owning a policy covering the insured, or from being entitled under such a policy to any indemnities, benefits, and rights provided therein. [L 1987, c 347, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-110 Requirements of other jurisdictions.

§431:10A-110 Requirements of other jurisdictions.
(a) Any policy of a foreign or alien insurer, when delivered or issued for delivery to any person in this State, may contain any provision which is not less favorable to the insured or the beneficiary than the provisions of this part and which is prescribed or required by the law of the state under which the insurer is organized.
(b) Any policy of a domestic insurer may, when issued for delivery in any state or country, contain any provision permitted or required by the laws of such state or country. [L 1987, c 347, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-111 Other policy provisions.

§431:10A-111 Other policy provisions.
No policy provision which is not subject to section 431:10A-105 or section 431:10A-106 shall make a policy, or any portion of the policy, less favorable in any respect to the insured or the beneficiary than the provisions which are subject to this part. [L 1987, c 347, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-112 Policy conflicting with this part.

§431:10A-112 Policy conflicting with this part.
A policy delivered or issued for delivery to any person in this State in violation of this part shall be held valid, but shall be construed as provided in this part. When any provision in a policy governed by this part is in conflict with any specific provision of this part, the rights, duties, and obligations of the insurer, the insured, and the beneficiary shall be governed by the provisions of this part. [L 1987, c 347, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-113 Filing procedure.

§431:10A-113 Filing procedure.
The commissioner may adopt reasonable rules concerning the procedure for the filing or submission of policies subject to this article as are necessary, proper, or advisable to the administration of this article. Each filing shall be accompanied by a $20 fee payable to the commissioner, which fee shall be deposited in the commissioner's education and training fund. This provision shall not abridge any other authority granted the commissioner by law. [L 1987, c 347, pt of §2; am L 1988, c 363, §2(3)]
Cross References
Commissioner's education and training fund, see §431:2-214.
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-114 Age limit.

§431:10A-114 Age limit.
If any policy of accident and health or sickness insurance contains a provision establishing as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective, and if such date falls within a period for which premium is accepted by the insurer or if the insurer accepts a premium after such date, the coverage provided by the policy will continue in force subject to any right of cancellation until the end of the period for which premium has been accepted. In the event the age of the insured has been misstated and if, according to the correct age of the insured, the coverage provided by the policy would not have become effective, or would have ceased prior to the acceptance of such premium or premiums, then the liability of the insurer shall be limited to the refund, upon request, of all premiums paid for the period not covered by the policy. [L 1987, c 347, pt of §2; am L 2002, c 155, §54]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-115 Coverage of newborn children.

§431:10A-115 Coverage of newborn children.
(a) All policies providing family coverage, as defined in section 431:10A-103 and reciprocal beneficiary family coverage, as defined in section 431:10A-601, on an expense incurred basis shall provide that the benefits applicable for children shall be payable for newborn infants from the moment of birth; provided that the coverage for newly born children shall be limited to the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities. If payment of a specific premium is required to provide coverage for a child, the policy may require that notification of birth and payment of the required premium must be furnished the insurer within thirty-one days after the date of birth in order to have the coverage continue beyond the thirty-one-day period.
(b) This section shall not be construed to provide or include coverages for routine well-baby services. The requirements of this section shall apply to all policies delivered or issued for delivery in this State more than one hundred twenty days after June 12, 1974. [L 1987, c 347, pt of §2; am L 1997, c 383, §6]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-116.2 Mammograms; referral not required.

§431:10A-116.2 Mammograms; referral not required.
(a) For purposes of the annual screening mammogram coverage required under section 431:10A-116, no insurer shall require an insured person forty years of age and older to obtain a referral from a primary care provider or other physician for an annual screening mammogram.
(b) If the screening mammogram indicates that follow up services are advisable, a referral shall be made to the patient's primary care physician or other physician, as designated by the patient. [L 2012, c 92, §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-116.5 In vitro fertilization procedure coverage.

§431:10A-116.5 In vitro fertilization procedure coverage.
(a) All individual and group accident and health or sickness insurance policies which provide pregnancy-related benefits shall include in addition to any other benefits for treating infertility, a one-time only benefit for all outpatient expenses arising from in vitro fertilization procedures performed on the insured or the insured's dependent spouse; provided that:
(1) Benefits under this section shall be provided to the same extent as the benefits provided for other pregnancy-related benefits;
(2) The patient is the insured or covered dependent of the insured;
(3) The patient's oocytes are fertilized with the patient's spouse's sperm;
(4) The:
(A) Patient and the patient's spouse have a history of infertility of at least five years' duration; or
(B) Infertility is associated with one or more of the following medical conditions:
(i) Endometriosis;
(ii) Exposure in utero to diethylstilbestrol, commonly known as DES;
(iii) Blockage of, or surgical removal of, one or both fallopian tubes (lateral or bilateral salpingectomy); or
(iv) Abnormal male factors contributing to the infertility;
(5) The patient has been unable to attain a successful pregnancy through other applicable infertility treatments for which coverage is available under the insurance contract; and
(6) The in vitro fertilization procedures are performed at medical facilities that conform to the American College of Obstetricians and Gynecologists guidelines for in vitro fertilization clinics or to the American Society for Reproductive Medicine minimal standards for programs of in vitro fertilization.
(b) For the purposes of this section, the term "spouse" means a person who is lawfully married to the patient under the laws of the State.
(c) The requirements of this section shall apply to all new policies delivered or issued for delivery in this State after June 26, 1987. [L 1987, c 332, §1 and L 1989, c 276, §4; am L 2003, c 212, §72; am L 2013, c 47, §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-116.6 Contraceptive services.

§431:10A-116.6 Contraceptive services.
(a) Notwithstanding any provision of law to the contrary, each employer group accident and health or sickness policy, contract, plan, or agreement issued or renewed in this State on or after January 1, 2000, shall cease to exclude contraceptive services or supplies for the subscriber or any dependent of the subscriber who is covered by the policy, subject to the exclusion under section 431:10A-116.7 and the exclusion under section 431:10A-607.
(b) Except as provided in subsection (c), all policies, contracts, plans, or agreements under subsection (a) that provide contraceptive services or supplies or prescription drug coverage shall not exclude any prescription contraceptive supplies or impose any unusual copayment, charge, or waiting requirement for such supplies.
(c) Coverage for oral contraceptives shall include at least one brand from the monophasic, multiphasic, and the progestin-only categories. A member shall receive coverage for any other oral contraceptive only if:
(1) Use of brands covered has resulted in an adverse drug reaction; or
(2) The member has not used the brands covered and, based on the member's past medical history, the prescribing health care provider believes that use of the brands covered would result in an adverse reaction.
(d) Coverage required by this section shall include reimbursement to a prescribing health care provider or dispensing entity for prescription contraceptive supplies intended to last for up to a twelve-month period for an insured.
(e) For purposes of this section:
"Contraceptive services" means physician-delivered, physician-supervised, physician assistant-delivered, advanced practice registered nurse-delivered, nurse-delivered, or pharmacist-delivered medical services intended to promote the effective use of contraceptive supplies or devices to prevent unwanted pregnancy.
"Contraceptive supplies" means all United States Food and Drug Administration-approved contraceptive drugs or devices used to prevent unwanted pregnancy.
(f) Nothing in this section shall be construed to extend the practice or privileges of any health care provider beyond that provided in the laws governing the provider's practice and privileges. [L 1993, c 365, §1; am L 1999, c 267, §2; am L 2003, c 201, §3 and c 212, §73; am L 2016, c 141, §6 and c 205, §2; am L 2017, c 67, §3; am L 2019, c 70, §16]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-117 Franchise plan.

§431:10A-117 Franchise plan.
(a) As used in this section, "employees" include:
(1) The officers, managers, and employees of the employer; and
(2) The individual proprietor or partners, if the employer is an individual proprietor or partnership.
(b) Insurance may be issued pursuant to this part on a franchise plan under the terms of which accident and health or sickness insurance is issued to:
(1) Five or more employees of any corporation, co-partnership, or individual employer, or any governmental corporation, agency, or department thereof; or
(2) Ten or more members, employees, or employees of members of any trade or professional association, of a labor union, or of any other association having had an active existence for at least two years; provided that:
(A) Such association or union has a constitution or bylaws and is formed in good faith for purposes other than that of obtaining insurance;
(B) Such persons, with or without their dependents, are issued the same form of an individual policy varying only as to amounts and kinds of coverage applied for; and
(C) There is an arrangement whereby the premiums on the policies may be paid to the insurer periodically by the employer, with or without payroll deductions, or by the association for its members, or by some designated person acting on behalf of the employer or association. [L 1987, c 347, pt of §2; am L 2002, c 155, §57; am L 2004, c 122, §33]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-118 Genetic information nondiscrimination in accident and health or sickness insurance coverage

§431:10A-118 Genetic information nondiscrimination in accident and health or sickness 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 1997, c 91, §1; am L 2003, c 212, §75]
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-119 Hospice care coverage.

§431:10A-119 Hospice care coverage.
(a) Any other law to the contrary notwithstanding, commencing on January 1, 2000, all authorized insurers that provide for payment of or reimbursement for hospice care shall reimburse hospice care services for each insured policyholder covered for hospice care according to the following:
(1) A minimum daily rate as set by the Centers for Medicare and Medicaid Services for hospice care;
(2) Reimbursement for residential hospice room and board expenses directly related to the hospice care being provided; and
(3) Reimbursement for each hospice referral visit during which a patient is advised of hospice care options, regardless of whether the referred patient is eventually admitted to hospice care.
(b) Every insurer shall provide notice to its policyholders regarding the coverage required by this section. Notice shall be in writing and in literature or correspondence sent to policyholders, beginning with calendar year 2000, along with any other mailing to policyholders, but in no case later than July 1, 2000. [L 1999, c 77, §4; am L 2011, c 43, §16]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-120 Medical foods and low-protein modified food products; treatment of inborn error of metabolism; notice.

§431:10A-120 Medical foods and low-protein modified food products; treatment of inborn error of metabolism; notice.
(a) Each policy of accident and health or sickness insurance, other than life insurance, disability income insurance, and long-term care insurance, issued or renewed in this State, each employer group health policy, contract, plan, or agreement issued or renewed in this State, all accident and health or sickness insurance policies issued or renewed in this State, all policies providing family coverages as defined in section 431:10A-103, and all policies providing reciprocal beneficiary family coverage as defined in section 431:10A-601, shall contain a provision for coverage for medical foods and low-protein modified food products for the treatment of an inborn error of metabolism for its policyholders or dependents of the policyholder in this State; provided that the medical food or low-protein modified food product is:
(1) Prescribed as medically necessary for the therapeutic treatment of an inborn error of metabolism; and
(2) Consumed or administered enterally under the supervision of a physician or osteopathic physician licensed under chapter 453.
Coverage shall be for at least eighty per cent of the cost of the medical food or low-protein modified food product prescribed and administered pursuant to this subsection.
(b) Every insurer shall provide notice to its policyholders regarding the coverage required by this section. The notice shall be in writing and prominently placed in any literature or correspondence sent to policyholders and shall be transmitted to policyholders during calendar year 2000 when annual information is made available to policyholders, or in any other mailing to policyholders, but in no case later than December 31, 2000.
(c) For the purposes of this section:
"Inborn error of metabolism" means a disease caused by an inherited abnormality of the body chemistry of a person that is characterized by deficient metabolism, originating from congenital defects or defects arising shortly after birth, of amino acid, organic acid, carbohydrate, or fat.
"Low-protein modified food product" means a food product that:
(1) Is specially formulated to have less than one gram of protein per serving;
(2) Is prescribed or ordered by a physician or osteopathic physician as medically necessary for the dietary treatment of an inborn error of metabolism; and
(3) Does not include a food that is naturally low in protein.
"Medical food" means a food that is formulated to be consumed or administered enterally under the supervision of a physician or osteopathic physician and is intended for the specific dietary management of a disease or condition for which distinctive nutritional requirements, based on recognized scientific principles, are established by medical evaluation. [L 1999, c 86, §2; am L 2002, c 155, §58; am L 2003, c 212, §76; am L 2009, c 11, §50]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-121 Coverage for diabetes.

§431:10A-121 Coverage for diabetes.
Each policy of accident and health or sickness insurance providing coverage for health care, other than an accident-only, specified disease, hospital indemnity, medicare supplement, long-term care, or other limited benefit health insurance policy, that is issued or renewed in this State, shall provide coverage for outpatient diabetes self-management training, education, equipment, and supplies, if:
(1) The equipment, supplies, training, and education are medically necessary; and
(2) The equipment, supplies, training, and education are prescribed by a health care professional authorized to prescribe. [L 2000, c 243, §2; am L 2002, c 155, §59]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-122 Colon cancer screening coverage.

§431:10A-122 Colon cancer screening coverage.
(a) Each policy of accident and health or sickness insurance providing coverage for health care, except for policies that only provide coverage for specified diseases or other limited benefit coverage, shall provide coverage for colorectal-cancer screening by all A and B grade screening modalities as recommended by the United States Preventive Services Task Force.
(b) Beginning March 1, 2011, all health insurance providers in Hawaii shall inform their insured about the risk associated with undiagnosed colorectal-cancer and encourage the insured to consult with the insured's physician about available screening options. [L 2010, c 157, §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-125 Primary care provider; advanced practice registered nurse.

§431:10A-125 Primary care provider; advanced practice registered nurse.
(a) Each policy of accident and health or sickness insurance delivered or issued for delivery in this State shall recognize advanced practice registered nurses, as defined under section 457-8.5(a), as participating providers, and shall include coverage for care provided by participating advanced practice registered nurses practicing within the scope of their licenses for purposes of health maintenance, diagnosis, or treatment, to the extent that the policy provides benefits for identical services rendered by another health care provider.
(b) Notwithstanding any other law to the contrary, an insurer may recognize a participating advanced practice registered nurse as a primary care provider if the insured's policy requires the selection of a primary care provider. The insurer shall include participating advanced practice registered nurses who practice as primary care providers on any publicly available list of participating primary care providers; provided that the insurer retains the right to determine the contracting criteria for a participating primary care provider.
(c) For the purposes of this section, "participating advanced practice registered nurse" means an advanced practice registered nurse who has contracted with the insurer to provide health care services to its insureds. [L 2009, c 169, §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-126 Cancer treatment.

§431:10A-126 Cancer treatment.
(a) Notwithstanding section 23-51, all individual and group accident and health or sickness insurance policies that include coverage or benefits for the treatment of cancer shall provide payment or reimbursement for all types of chemotherapy that are considered medically necessary as defined in section 432E-1.4.
(b) The cost-sharing for generic and non-generic oral chemotherapy shall be provided at the same or lower amount or percentage as is applied to generic and non-generic intravenously administered chemotherapy; provided that an insurer shall not increase the cost-share for intravenously administered chemotherapy in order to achieve compliance with this subsection.
(c) Individual and group accident and health or sickness insurance policies shall not increase enrollee cost-sharing for non-generic medications used for the treatment of cancer to any greater extent than such policies increase enrollee cost-sharing for other covered non-generic medication.
(d) For the purposes of this section:
"Cost-share" or "cost-sharing" means copayment, coinsurance, or deductible provisions applicable to coverage for medications or treatments.
"Intravenously administered chemotherapy" means a physician-prescribed cancer treatment that is administered through injection directly into the patient's circulatory system by a physician, physician assistant, nurse practitioner, nurse, or other medical personnel under the supervision of a physician and in a hospital, medical office, or other clinical setting.
"Oral chemotherapy" means a United States Food and Drug Administration-approved, physician-prescribed cancer treatment that is taken orally in the form of a tablet or capsule and may be administered in a hospital, medical office, or other clinical setting or may be delivered to the patient for self-administration under the direction or supervision of a physician outside of a hospital, medical office, or other clinical setting.
(e) This section shall not apply to an accident-only, specified disease, hospital indemnity, long-term care, or other limited-benefit health insurance policy. [L 2009, c 168, §1; am L 2012, c 30, §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-134 Human immunodeficiency virus and acquired immunodeficiency syndrome screening coverage.

§431:10A-134 Human immunodeficiency virus and acquired immunodeficiency syndrome screening coverage.
(a) Each policy of accident and health or sickness insurance issued or renewed in this State, except for policies that only provide coverage for specified diseases or other limited benefit coverage as described in section 431:10A-607, shall provide coverage for annual screenings for sexually transmitted diseases, including screenings for human immunodeficiency virus and acquired immunodeficiency syndrome.
(b) Each accident and health or sickness insurer shall reimburse all costs associated with the coverage under subsection (a) to any physician or health care provider complying with this section. [L 2016, c 204, §2; am L 2019, c 70, §33]
Note
Applicability of section. L 2016, c 204, § §6, 8.
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-140 Formulary; accessibility requirements.

§431:10A-140 Formulary; accessibility requirements.
(a) Each insurer offering or renewing an individual or group accident and health or sickness insurance policy on or after January 1, 2017, shall provide the following information via a public website and through a toll-free number that is posted on the insurer's website:
(1) Its formulary; provided that notice of any changes due to the addition of a new drug or deletion of any existing drug shall be made available no later than seventy-two hours after the effective date of the change; provided further that notice of other changes, including drug strength or form, shall be made available within fourteen calendar days of the effective date of the change;
(2) Provide a system that allows an insured or potential insured to determine whether prescription drugs are covered under the plan's medical benefits and typically administered by a provider, along with any cost-sharing imposed on such drugs;
(3) Indicate a dollar amount range of cost-sharing typically paid by an insured of each specific drug included on the formulary based on the information the insurer has available, as follows:
(A) $100 and under: $;
(B) Over $100 to $250: $$;
(C) Over $250 to $500: $$$;
(D) Over $500 to $1,000: $$$$; and
(E) Over $1,000: $$$$$; and
(4) Display standardized content for the formulary for each product offered by the plan pursuant to recommendations made by the formulary accessibility working group established pursuant to Act 197, Session Laws of Hawaii 2015.
(b) For the purposes of this section, "formulary" means the complete list of drugs preferred for use and eligible for coverage under a policy, including drugs covered under the policy's pharmacy benefit and medical benefit as defined by the health care service plans.
(c) This section shall not apply to limited benefit health insurance as provided in section 431:10A-607; provided further that this section shall not apply to medicare, medicaid, or other federally financed plans. [L 2015, c 197, §1; am L 2019, c 70, §33]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-141 Extension of dependent coverage.

§431:10A-141
Extension of dependent coverage.
An individual policy of accident and health or sickness insurance and a health insurer offering individual accident and health or sickness insurance coverage that provides dependent coverage of children shall continue to make that coverage available for an adult child until the child turns twenty-six years of age. Nothing in this section shall require a policy or health insurer to make coverage available for a child of a child receiving dependent coverage. [L 2018, c 111, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-142 Prohibition of preexisting condition exclusions.

§431:10A-142
Prohibition of preexisting condition exclusions.
(a) No individual policy of accident and health or sickness insurance issued or renewed in this State shall impose any preexisting condition exclusion.
(b) For purposes of this section, a "preexisting condition exclusion" means a limitation or exclusion of benefits, including a denial of coverage, based on the fact that the condition was present before the effective date of coverage (or if coverage is denied, the date of the denial) under an individual policy of accident and health or sickness insurance, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before that day, and includes any condition.
The term "preexisting condition exclusion" includes any limitation or exclusion of benefits, including a denial of coverage, applicable to an individual as a result of information relating to an individual's health status before the individual's effective date of coverage (or if coverage is denied, the date of the denial) under an individual policy of accident and health or sickness insurance, such as a condition identified as a result of a pre-enrollment questionnaire or physical examination given to the individual or a review of medical records relating to the pre-enrollment period. [L 2018, c 111, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-143 Prohibited discrimination in premiums or contributions.

§431:10A-143
Prohibited discrimination in premiums or contributions.
No individual policy of accident and health or sickness insurance and no health insurer offering individual accident and health or sickness insurance coverage issued or renewed in this State shall require an individual, as a condition of enrollment or continued enrollment under the policy, to pay a premium or contribution based on the individual's gender that is greater than the premium or contribution for a similarly situated individual of the opposite gender who is covered under the same policy or a substantially similar policy offered by the same insurer. [L 2018, c 111, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-144 Reimbursement to providers.

§431:10A-144
Reimbursement to providers.
(a) Coverage for services required by this part shall include reimbursement to health care providers who perform services required by this part, or to the insured member, as appropriate.
(b) Whenever an individual or group policy, contract, plan, or agreement provides for reimbursement for any service, a health care provider who performs a service shall be eligible for reimbursement for the performed service to the extent the health care provider is eligible for such reimbursement under the policy, contract, plan, or agreement, and is acting within the scope of the provider's license or certification under state law.
(c) For purposes of this section, "health care provider" means a provider of services, as defined in title 42 United States Code section 1395x(u); a provider of medical and other health services, as defined in title 42 United States Code section 1395x(s); and a practitioner licensed by the State and working within the practitioner's scope of practice. [L 2019, c 70, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-202 Health care groups.

§431:10A-202 Health care groups.
A policy of group disability insurance may be issued to a corporation, as policyholder, existing primarily for the purpose of assisting individuals who are its subscribers in securing medical, hospital, dental, and other health care services for themselves and their dependents, covering all and not less than five hundred such subscribers and dependents, with respect only to medical, hospital, dental, and other health care services. [L 1987, c 347, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-203 Standard provisions.

§431:10A-203 Standard provisions.
Every policy of group or blanket disability insurance shall contain in substance the following provisions, or provisions which in the opinion of the commissioner are more favorable to the individuals insured, or at least as favorable to such individuals and more favorable to the policyholder. No such policy of group or blanket disability insurance shall contain any provision relative to notice or proof of loss, or to the time for paying benefits, or to the time within which suit may be brought upon the policy, which in the opinion of the commissioner is less favorable to the individuals insured than would be permitted by the standard provisions required for individual accident and health or sickness insurance policies.
(1) Representations. There shall be a provision that:
(A) All statements, made by the policyholder or by the individuals insured, shall be deemed to be representations and not warranties;
(B) No statement, made in the application by the policyholder, shall be used in any contest unless a copy of the application, if any, of the policyholder shall be attached to the policy when issued;
(C) No statement made by any individual insured shall be used in any contest unless a copy of the instrument containing the statement is or has been furnished to such individual or to the individual's beneficiary, if any; and
(D) A misrepresentation, unless it is made with actual intent to deceive or unless it materially affects either the acceptance of the risk or the hazard assumed by the insurer, shall not prevent a recovery on the policy.
(2) Certificates. There shall be a provision that the insurer shall issue to the policyholder for delivery to each insured employee or member, an individual certificate setting forth in summary form a statement of the essential features of the insurance coverage, and to whom the benefits are payable. If family members are insured, only one certificate need be issued for each family. This paragraph shall not apply to blanket disability insurance policies.
(3) Additional insureds. There shall be a provision that to the group originally insured may be added, from time to time, eligible new employees, members, or dependents, as the case may be, in accordance with the terms of the policy.
(4) Age limitations. There shall be a provision specifying:
(A) The ages, if any, to which the insurance provided shall be limited;
(B) The ages, if any, for which additional restrictions are placed on benefits; and
(C) The additional restrictions placed on the benefits at such ages.
(5) Payment of premiums. There shall be a provision that all premiums due under the policy shall be remitted by the employer or employers of the persons insured, by the policyholder or by some other designated person acting on behalf of the association or group insured, to the insurer on or before the due date thereof within such grace period as may be specified therein. [L 1987, c 347, pt of §2; am L 1989, c 195, §24; am L 2002, c 155, §61]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-204 Optional provision, examination and autopsy.

§431:10A-204 Optional provision, examination and autopsy.
There may be a provision that the insurer shall have the right and opportunity to examine the person of any individual covered under the policy when and so often as it may reasonably require during the pendency of claim under the policy and also the right and opportunity to make an autopsy in case of death where it is not prohibited by law. [L 1987, c 347, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-205 Payment of benefits.

§431:10A-205 Payment of benefits.
(a) The benefits payable under any policy or contract of group or blanket disability insurance shall be payable to the insured member of the group or to the beneficiary designated by the insured member, other than the policyholder, subject to provisions of the policy in the event the claimant is insane or otherwise incompetent, or in the event there is no designated beneficiary as to all or any part of any sum payable at the death of the individual insured; provided, that if the entire cost of the insurance has been borne by the employer such benefits may be made payable to the employer.
(b) Any group or blanket disability policy may provide that all or any portion of any indemnities provided by the policy on account of hospital, nursing, medical, or surgical services may, at the insurer's option, be paid directly to the hospital or person rendering such services, but the policy may not require that the service be rendered by a particular hospital or person. Payment so made shall discharge the insurer's obligation with respect to the amount so paid.
(c) No group disability income policy shall contain any provision integrating the benefits of the policy with social security benefits whereby the amount of the disability benefit actually being paid to the disabled person under the terms and conditions of the policy will be diminished when there occurs an increase in social security benefits either by operation of amendments to the Social Security Act or by cost of living adjustments which become effective after the first day the disabled person becomes entitled to benefits. [L 1987, c 347, pt of §2]
Case Notes
Properly licensed HMOs, like plaintiff, were authorized pursuant to §432D-1 to "provide or arrange", at their option, for the closed panel health care services required under the managed care plan program; accident and health insurers were authorized under subsection (b) to arrange for medical services for members using a defined network of providers, i.e., particular "hospitals or persons"; thus, article 431:10A and chapter 432D authorized both accident and health insurers and HMOs, as risk-bearing entities, to provide the closed panel product required by the managed care plan contracts. 126 H. 326, 271 P.3d 621 (2012).
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-206 Coverage of newborn children.

§431:10A-206 Coverage of newborn children.
All group or blanket disability policies providing family coverage, as defined in section 431:10A-103 and reciprocal beneficiary family coverage, as defined in section 431:10A-601, on an expense incurred basis shall provide coverage for newborn children in compliance with section 431:10A-115. [L 1987, c 347, pt of §2; am L 1997, c 383, §7; am L 2002, c 155, §62]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-207 Coverage for specific services.

§431:10A-207 Coverage for specific services.
Every person insured under a group or blanket disability insurance policy shall be entitled to the reimbursements and coverages specified in section 431:10A-116. [L 1987, c 347, pt of §2; am L 2002, c 155, §63]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-208 Qualified medical child support order.

§431:10A-208 Qualified medical child support order.
(a) An employer, who provides health coverage to dependent children of an employee, shall recognize a child identified in a qualified medical child support order as an eligible dependent without regard to any enrollment season restrictions.
(b) A qualified medical child support order shall:
(1) Specify the name and last known mailing address, if any, of the plan member and the name and mailing address of each recipient child covered by the order;
(2) Include a reasonable description of the type of coverage to be provided to the recipient child, or the manner in which the type of coverage is to be determined;
(3) State the period during which it applies;
(4) Specify the plan to which it applies; and
(5) Not require a plan to provide any type or form of benefit or option that the plan does not otherwise provide.
[L 1994, c 145, §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-209 Association health plan policy; compliance with state law.

§431:10A-209 Association health plan policy; compliance with state law.
(a) Every association health plan policy issued in this State shall comply with all laws of this State, regardless of the domicile of the association that has issued the policy.
(b) For the purposes of this section, "association health plan policy" means a policy issued by a voluntary association of employers formed in this State or another state that is authorized to issue association health plans under the regulations of the United States Department of Labor. [L 2018, c 199, §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-210 Extension of dependent coverage.

§431:10A-210 Extension of dependent coverage.
A group policy of accident and health or sickness insurance and a health insurer offering group accident and health or sickness insurance coverage that provides dependent coverage of children shall continue to make that coverage available for an adult child until the child turns twenty-six years of age. Nothing in this section shall require a policy or health insurer to make coverage available for a child of a child receiving dependent coverage. [L 2018, c 111, pt of §3]
2023 Hawaii Revised Statutes › Title 24. Insurance › 431. Insurance Code › 431:10A-211 Prohibition of preexisting condition exclusions.

§431:10A-211 Prohibition of preexisting condition exclusions.
(a) No group policy of accident and health or sickness insurance issued or renewed in this State shall impose any preexisting condition exclusion.
(b) For purposes of this section, a "preexisting condition exclusion" means a limitation or exclusion of benefits, including a denial of coverage, based on the fact that the condition was present before the effective date of coverage (or if coverage is denied, the date of the denial) under a group policy of accident and health or sickness insurance, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before that day and includes any condition.
The term "preexisting condition exclusion" includes any limitation or exclusion of benefits, including a denial of coverage, applicable to an individual as a result of information relating to an individual's health status before the individual's effective date of coverage (or if coverage is denied, the date of the denial) under a group policy of accident and health or sickness insurance, such as a condition identified as a result of a pre-enrollment questionnaire or physical examination given to the individual, or review of medical records relating to the pre-enrollment period. [L 2018, c 111, pt of §3]