reglab/statecodes huggingface dataset:
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:2-703 Penalties.

§432:2-703 Penalties.
(a) Any person who wilfully makes a false or fraudulent statement in or relating to an application for membership or for the purpose of obtaining money from or a benefit in any society, shall upon conviction be fined not less than $100 nor more than $500 or imprisoned for not less than thirty days nor more than one year, or both.
(b) Any person who wilfully makes a false or fraudulent statement in any verified report or declaration under oath required or authorized by this article, or of any material fact or thing contained in a sworn statement concerning the death or disability of an insured for the purpose of procuring payment of a benefit named in the certificate, shall be guilty of perjury and shall be subject to the penalties therefor prescribed by law.
(c) Any person who solicits membership for, or in any manner assists in procuring membership in, any society not licensed to do business in this State shall upon conviction be fined not less than $50 nor more than $200.
(d) Any person guilty of a wilful violation of, or neglect or refusal to comply with, the provisions of this article for which a penalty is not otherwise prescribed, shall upon conviction, be subject to a fine not exceeding $200.
(e) All penalties collected pursuant to this section and section 432:2-108 shall be deposited to the credit of the compliance resolution fund. [L 1987, c 347, pt of §2; am L 2015, c 63, §17]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:2-705 Severability.

§432:2-705
Severability.
If any provision of this article or the application of such provision to any circumstance is held invalid, the remainder of the article or the application of the provision to other circumstances, shall not be affected thereby. [L 1987, c 347, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432C. Nonprofit Entities; Conversion of Assets › 432C-1 Definitions.

§432C-1 Definitions.
As used in this chapter:
"Commissioner" means the insurance commissioner.
"Conversion" means the transfer or sale of a significant amount of a nonprofit entity's assets to a for-profit entity or through any other means as determined by the commissioner. The department of commerce and consumer affairs' business registration division shall assist the commissioner in determining whether a conversion is about to occur or has occurred. As used in this definition, "significant" means twenty per cent or more of the assets of the nonprofit entity or an amount where the for-profit entity gains control or majority ownership of total assets of the nonprofit entity.
"For-profit entity" means a corporation organized under chapter 414, including a stock insurance company.
"Nonprofit entity" means any charitable organization operating pursuant to Title 26 United States Code section 501(c)(3), (4), (8), (9), (26), or 501(e), and whose primary purpose is to provide accident and health or sickness insurance coverage or any type of accident and health or sickness insurance benefits to its members or the public.
[L 1998, c 260, pt of §2; am L 2002, c 40, §74; am L 2003, c 212, §124]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432C. Nonprofit Entities; Conversion of Assets › 432C-2 Application for conversion.

§432C-2 Application for conversion.
(a) A nonprofit entity shall file an application with the commissioner at least six months prior to a proposed conversion. The application shall include a report of the activities of the nonprofit entity and a plan for the conversion including the following:
(1) A board resolution indicating that a majority of the board of directors has approved the plan for conversion;
(2) Copies of the original and amended articles of incorporation, if any;
(3) The nature of the public benefit or charitable activities undertaken by the nonprofit entity;
(4) Expenditures incurred by the nonprofit entity on the public benefit or charitable activities;
(5) A means that establishes that the conversion shall not be prejudicial to the subscribers, contract holders, or residents of this State;
(6) A comparative premium rate analysis of the nonprofit entity's major plans and products, with the analysis comparing actual premium rates for the past three years prior to the proposed conversion and projected premium rates for three years following the proposed conversion. The analysis shall address the projected impact, if any, of the proposed conversion upon the nonprofit entity's future underwriting profit, investment income, and loss and claim reserves, including the effect, if any, of adverse market or risk selection upon the reserves; and
(7) A valuation of all assets held by the nonprofit entity.
(b) The commissioner may request any additional information that the commissioner deems necessary to carry out this chapter. [L 1998, c 260, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432C. Nonprofit Entities; Conversion of Assets › 432C-3 Approval process.

§432C-3 Approval process.
(a) No nonprofit entity may engage in a conversion without prior approval of the application for conversion by the commissioner. Any conversion without the commissioner's approval shall be voidable by the commissioner.
(b) Prior to approval of the conversion plan, the commissioner shall determine the fair market value of the assets of the nonprofit entity and shall ensure that the assets of the nonprofit entity are transferred to another nonprofit entity at the time of conversion pursuant to section [432C-5].
(c) After reviewing the report and plan for conversion of the nonprofit entity, if the commissioner finds any discrepancy in the valuation of the assets of the nonprofit entity, the commissioner may obtain an independent party to provide a valuation of the assets. The commissioner shall have the discretion of making a final determination of the valuation of the assets of the nonprofit entity; provided that any issues arising from valuation are brought forth during the public hearing.
(d) A public hearing shall be conducted pursuant to chapter 91 prior to approving or disapproving the conversion. Prior to approving or disapproving the conversion, the commissioner may investigate and consider any matter or issue raised at the public hearing.
(e) Within sixty days after the public hearing, the commissioner shall disapprove or approve the conversion or approve an amended conversion plan; provided that the commissioner may extend this period if the commissioner deems more time is needed to resolve any issues brought forth during the public hearing or upon mutual consent of the nonprofit entity and the commissioner.
(f) The commissioner shall approve the conversion if the commissioner finds all of the following have been met:
(1) The conversion plan is in compliance with section 432C-2;
(2) The plan is fair and reasonable and not contrary to law or to the interests of subscribers, contract holders, and the residents of the State; and
(3) Upon conversion, the for-profit corporation will meet the standards and conditions applicable to stock insurance companies, including minimum surplus requirements.
(g) The commissioner shall issue an order approving or disapproving the conversion or approving an amended conversion plan. [L 1998, c 260, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432C. Nonprofit Entities; Conversion of Assets › 432C-4 Directors, officers of nonprofit entity; prohibition.

§432C-4 Directors, officers of nonprofit entity; prohibition.
(a) Directors or officers of a nonprofit entity are prohibited from directly benefiting from the conversion.
(b) No officer of the nonprofit entity who is employed by the nonprofit entity at the time the conversion application is submitted, at the time of conversion, or for a one-year period after conversion shall be employed by the for-profit entity. [L 1998, c 260, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432C. Nonprofit Entities; Conversion of Assets › 432C-5 Transfer of assets to other nonprofit entities.

§432C-5 Transfer of assets to other nonprofit entities.
The commissioner shall determine prior to any conversion, the nonprofit entities, if any, that are eligible to receive assets from the converting nonprofit entity. The charitable mission and grant-making functions of each eligible nonprofit entity must:
(1) Be dedicated to promoting or serving the health care needs of residents of the State;
(2) Not be in direct competition with the converting nonprofit entity; and
(3) Be in existence and have qualified for tax-exempt status under Title 26 United States Code section 501(c)(3), (4), (8), (9), (26), or (e), before the transfer of assets. [L 1998, c 260, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432C. Nonprofit Entities; Conversion of Assets › 432C-6 For-profit entity; after conversion.

§432C-6 For-profit entity; after conversion.
After conversion, the for-profit entity shall not be subject to this chapter, but if a stock insurance company, shall be in conformance with title 24. [L 1998, c 260, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-1.5 Bona fide trade associations.

§432D-1.5 Bona fide trade associations.
(a) At the option of a bona fide trade association, or its designated agent, a health maintenance organization that sells health insurance to the bona fide trade association shall treat the bona fide trade association and its members as a group for the purpose of issuing a group contract; provided that:
(1) The bona fide trade association shall have been formed for purposes other than obtaining insurance;
(2) The health maintenance organization shall be prohibited from restricting, in any manner, the number or types of health plans issued by another insurance entity that the bona fide trade association may offer to its members, including but not limited to such restrictions as clauses that reduce competition between insurers or clauses that require a bona fide trade association to allow an insurer to match the price or terms offered by another insurer; and
(3) Each member of the bona fide trade association shall not be required to be insured under the group policy;
and provided further that this section shall be inapplicable if less than two persons from the bona fide trade association seek to be insured under the group policy.
(b) As used in this section:
"Bona fide trade association" means an association of persons organized to promote common interests and comprised of persons engaged in a business, trade, or profession that:
(1) Has been actively in existence for five years;
(2) Has been formed and maintained in good faith for purposes other than obtaining insurance;
(3) Does not condition membership in the association on any health status related factor pertaining to an individual (including an employee of an employer or a dependent of an employee);
(4) Makes health insurance coverage offered through the association available to all members regardless of any health status related factor pertaining to such members (or individuals eligible for coverage through a member);
(5) Does not make health insurance coverage offered through the association available other than in connection with a member of the association; and
(6) Meets such additional requirements as may be imposed under state law. [L 2004, c 118, § §3, 5; am L 2006, c 41, §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-4 Fiduciary responsibilities.

§432D-4 Fiduciary responsibilities.
(a) Any director, officer, employee, or partner of a health maintenance organization 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 health maintenance organization shall maintain in force a fidelity bond or fidelity insurance on such employees, officers, directors, and partners in an amount not less than $250,000 for each health maintenance organization or a maximum of $5,000,000 in aggregate maintained on behalf of health maintenance organizations owned by a common parent corporation, or such sum as may be prescribed by the commissioner. [L 1995, c 179, pt of §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-5 Annual and quarterly reports.

§432D-5 Annual and quarterly reports.
(a) Every health maintenance organization shall file annually, on or before March 1, a report verified by at least two principal officers covering the preceding calendar year. Each health maintenance organization shall file quarterly with the commissioner, on or before the forty-fifth day after each quarter, a copy of its quarterly report verified by at least two principal officers. These reports shall comply with sections 431:3-301 and 431:3-302. The commissioner may prescribe the forms on which the reports are to be filed. In addition, the health maintenance organization annually shall file with the commissioner the following by the dates specified:
(1) An audit, by an independent certified public accountant or an accounting firm designated by the health maintenance organization of the financial statements, reporting the financial condition and results of operations of the health maintenance organization on or before June 1, or a later date as the commissioner upon request or for cause may specify. The health maintenance organization, 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 health maintenance organization's designation within fifteen days of receipt of the health maintenance organization's notice, and the health maintenance organization shall be required to designate another independent certified public accountant or accounting firm. The audit required by this paragraph shall be prepared in accordance with the National Association of Insurance Commissioners' accounting practices and procedures manual and rules adopted by the commissioner following the practices and procedures prescribed by the National Association of Insurance Commissioners;
(2) A list of the providers who have executed a contract that complies with section 432D-8(d) 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 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) The commissioner may suspend or revoke the certificate of authority of any health maintenance organization who fails to file any of the documents required under subsection (a). In lieu or in addition to the suspension or revocation of the certificate of authority of any health maintenance organization, the commissioner may fine the health maintenance organization not less than $100 and not more than $500 for each day of delinquency. [L 1995, c 179, pt of §1; am L 1999, c 247, §1; am L 2000, c 74, §4; am L 2003, c 212, §125; am L 2010, c 116, §3]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-6 Information to enrollees or subscribers.

§432D-6 Information to enrollees or subscribers.
(a) The health maintenance organization shall provide to its subscribers a list of providers and participating providers, upon enrollment and reenrollment.
(b) Every health maintenance organization 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 health maintenance organization shall provide to subscribers information on how services may be obtained, where additional information on access to services may be obtained, a description of the internal grievance procedures, and a telephone number for the enrollee to contact the health maintenance organization at no cost to the enrollee.
(d) For the purpose of this section "material change" means any major change in provider or participating provider agreements. [L 1995, c 179, pt of §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-7 Investments.

§432D-7 Investments.
All investments permitted under section 432D-3(a)(1) may be considered admitted assets in determination of net worth; provided that these investments are in compliance with article 6 of chapter 431. [L 1995, c 179, pt of §1; am L 2000, c 74, §5; am L 2003, c 212, §126]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-9.5 Reserve credit for reinsurance.

§432D-9.5 Reserve credit for reinsurance.
Any health maintenance organization that takes credit for reserves on risks ceded to a reinsurer shall be subject to provisions of chapter 431 related to credit for reinsurance. [L 2000, c 74, §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-10 Enrollment period.

§432D-10 Enrollment period.
(a) In the event of an insolvency of a health maintenance organization, upon order of the commissioner, all other carriers offered as alternatives to the insolvent health maintenance organization at a group's last regular enrollment period shall offer to those members of the group who enrolled in the insolvent health maintenance organization a thirty-day enrollment period commencing upon the date of insolvency. Each carrier shall offer the enrollees of the insolvent health maintenance organization the same coverages and rates that it had offered to the enrollees of the group at its last regular enrollment period.
(b) If no other carrier had been offered to some groups enrolled in the insolvent health maintenance organization, or if the commissioner determines that the other health benefit plans lack sufficient health care delivery resources to assure that health care services will be available and accessible to all of the group's enrollees of the insolvent health maintenance organization, then the commissioner shall equitably allocate the insolvent health maintenance organization's group contracts for such groups among all health maintenance organizations that operate within a portion of the insolvent health maintenance organization's service area, taking into consideration the health care delivery resources of each health maintenance organization. Each health maintenance organization to which a group is so allocated shall offer the group the health maintenance organization's existing coverage that is most similar to each group's coverage with the insolvent health maintenance organization at rates determined in accordance with the successor health maintenance organization's existing rating methodology.
(c) The commissioner also shall allocate equitably the insolvent health maintenance organization's nongroup enrollees who are unable to obtain other coverage among all health maintenance organizations which operate within a portion of the insolvent health maintenance organization's service area, taking into consideration the health care delivery resources of each health maintenance organization. Each health maintenance organization to which nongroup enrollees are allocated shall offer such nongroup enrollees the health maintenance organization's existing coverage for individual or conversion coverage as determined by the enrollee's type of coverage in the insolvent health maintenance organization at rates determined in accordance with the successor health maintenance organization's existing rating methodology. Successor health maintenance organizations that do not offer direct nongroup enrollment may aggregate all of the allocated nongroup enrollees into one group for rating and coverage purposes. [L 1995, c 179, pt of §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-11 Replacement coverage.

§432D-11 Replacement coverage.
(a) For purposes of this chapter, "discontinuance" means the termination of the contract between the group contract holder and a health maintenance organization due to the insolvency of the health maintenance organization, and does not refer to the termination of any agreement between any individual enrollee and the health maintenance organization.
(b) Any carrier providing replacement coverage with respect to group hospital, medical, or surgical expense or service benefits within a period of sixty days from the date of discontinuance of a prior health maintenance organization contract or policy providing such hospital, medical, or surgical expense or service benefits shall immediately cover all enrollees who were validly covered under the previous health maintenance organization 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 or hospital confinement or pregnancy.
(c) 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 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 1995, c 179, pt of §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-12 Powers of insurers and hospital and medical service corporations.

§432D-12 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 health maintenance organization under the provisions of this chapter. Notwithstanding any other law to the contrary, any two or more insurance companies, hospital or medical service corporations, or subsidiaries or affiliates thereof, may jointly organize and operate a health maintenance organization. The business of insurance is deemed to include the providing of health care by a health maintenance organization 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, an insurer or a hospital or medical service corporation may contract with a health maintenance organization to provide insurance or similar protection against the cost of care provided through health maintenance organizations and to provide coverage in the event of the failure of the health maintenance organization to meet its obligations. The enrollees of a health maintenance organization constitute a permissible group under such laws. Among other things, under such contracts, the insurer or hospital or medical service corporation may make benefit payments to health maintenance organizations for health care services rendered by providers. [L 1995, c 179, pt of §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-13 Examinations.

§432D-13 Examinations.
(a) The commissioner may examine the affairs of any health maintenance organization or of any providers with whom such organization has contracts, agreements, or other arrangements as often as is reasonably necessary for the protection of the interests of the people of this State but shall make such examination not fewer than once every five years for health maintenance organizations domiciled in this State.
(b) Every health maintenance organization and provider shall submit its books and records for examination and in every way facilitate the completion of the examination. In the event a health maintenance organization or the provider fails to comply with the directions of the commissioner, the commissioner may examine the affiliates of the health maintenance organization 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 health maintenance organization and the principals of providers concerning their business.
(c) The cost of examinations under this section shall be assessed against the health maintenance organization being examined and remitted to the commissioner for deposit into the compliance resolution fund.
(d) In lieu of such examination, the commissioner may accept the report of an examination made by the commissioner or director of the department of health of another state. [L 1995, c 179, pt of §1; am L 2004, c 122, §91; am L 2012, c 251, §12]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-15 Rehabilitation, liquidation, or conservation of health maintenance organizations.

§432D-15 Rehabilitation, liquidation, or conservation of health maintenance organizations.
(a) Any rehabilitation, liquidation, or conservation of a health maintenance organization shall be deemed to be the rehabilitation, liquidation, or conservation of an insurance company and shall be conducted under the supervision of the commissioner pursuant to the law governing the rehabilitation, liquidation, or conservation of insurance companies. The commissioner may apply for an order directing the commissioner to rehabilitate, liquidate, or conserve a health maintenance organization upon any one or more grounds set out in article 15 of chapter 431, or when in the commissioner's opinion, the continued operation of the health maintenance organization would be hazardous either to the enrollees or to the general public. Enrollees shall have the same priority in the event of liquidation or rehabilitation as the law provides to policyholders of an insurer.
(b) For purpose of determining the priority of distribution of general assets, claims of enrollees and enrollees' beneficiaries shall have the same priority as established by article 15 of chapter 431, for policyholders and beneficiaries of insureds of insurance companies. If an enrollee is liable to any provider for services provided pursuant to and covered by the health care plan, that liability shall have the status of an enrollee claim for distribution of general assets. Any provider who is obligated by statute or agreement to hold enrollees harmless from liability for services provided pursuant to and covered by a health care plan shall have a priority of distribution of the general assets immediately following that of enrollees and enrollees' beneficiaries as described herein, and immediately preceding the priority of distribution described in article 15 of chapter 431. [L 1995, c 179, pt of §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-16 Summary orders and supervision.

§432D-16 Summary orders and supervision.
(a) Whenever the commissioner determines that the financial condition of any health maintenance organization 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 health maintenance organization to take such action as may be reasonably necessary to rectify such condition or violation, including but not limited to one or more of the following:
(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 health maintenance organization's capital and surplus by contribution; or
(6) Taking such other steps as the commissioner may deem appropriate under the circumstances.
(b) For purposes of this section, the violation by a health maintenance organization of any law of this State to which such health maintenance organization is subject shall be deemed a violation of this chapter.
(c) The commissioner is authorized, by rule, to set uniform standards and criteria for early warning that the continued operation of any health maintenance organization might be hazardous to its enrollees, creditors, or the general public and to set standards for evaluating the financial condition of any health maintenance organization, 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 1995, c 179, pt of §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-17 Fees

§432D-17 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 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 and penalties collected pursuant to section 432D-14 shall be deposited to the credit of the compliance resolution fund. [L 1995, c 179, pt of §1; am L 1999, c 247, §2; am L 2012, c 251, §13; am L 2015, c 63, §18; am L 2021, c 110, §21]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-18 Penalties and enforcement.

§432D-18 Penalties and enforcement.
(a) The commissioner, in lieu of suspension or revocation of a certificate of authority, may impose an administrative fine pursuant to section 432D-14(b).
(b) If the commissioner, for any reason, has cause to believe that any violation of this chapter has occurred or is threatened, the commissioner may give notice to the health maintenance organization and to the representatives, or other persons who appear to be involved in such suspected violation, to arrange a conference with the alleged violators or their authorized representatives for the purpose of attempting to ascertain the facts relating to such suspected violation and, in the event it appears that any violation has occurred or is threatened, to arrive at an adequate and effective means of correcting or preventing such violation. Proceedings under this subsection shall not be governed by any formal procedural requirements, and may be conducted in such manner as the commissioner may deem appropriate under the circumstances. However, unless consented to by the health maintenance organization, no order may result from a conference until the requirements of this section are satisfied.
(c) The commissioner may issue an order directing a health maintenance organization or a representative of a health maintenance organization to cease and desist from engaging in any act or practice in violation of the provisions of this chapter. Any person aggrieved by an order of the commissioner under this section may obtain judicial review of the order in the manner provided for by chapter 91.
(d) In the case of any violation of the provisions of this chapter, if the commissioner elects not to issue a cease and desist order, or in the event of noncompliance with a cease and desist order issued pursuant to subsection (c), the commissioner may institute a proceeding to obtain injunctive or other appropriate relief in any court of competent jurisdiction.
(e) Notwithstanding any other provisions of this chapter, if a health maintenance organization fails to comply with the net worth requirement of this chapter, the commissioner may take appropriate action to assure that the continued operation of the health maintenance organization will not be hazardous to its enrollees. [L 1995, c 179, pt of §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-19 Statutory construction and relationship to other laws.

§432D-19 Statutory construction and relationship to other laws.
(a) Except as provided in subsection (d) and otherwise provided in this chapter, the insurance laws and hospital or medical service corporation laws shall not apply to the activities authorized and regulated under this chapter of any health maintenance organization granted a certificate of authority under this chapter. This chapter shall not apply to an insurer or hospital or medical service corporation licensed and regulated pursuant to the insurance laws or the hospital or medical service corporation laws of this State except with respect to its health maintenance organization activities authorized and regulated pursuant to this chapter.
(b) Solicitation of enrollees by a health maintenance organization granted a certificate of authority, or its representatives, shall not be construed to violate any provision of law relating to solicitation or advertising by health professionals.
(c) Any health maintenance organization granted a certificate of authority under this chapter shall not be deemed to be practicing medicine or osteopathic medicine and shall be exempt from the provision of chapter 453 relating to the practice of medicine or osteopathic medicine.
(d) Article 2, article 2D, part IV of article 3, article 6, part III of article 7, article 9A, article 13, article 14G, and article 15 of chapter 431, and sections 431:3-301, 431:3-302, 431:3-303, 431:3-304, 431:3-305, 431:10-225, and 431:10-226.5, and the powers granted by those provisions to the commissioner shall apply to health maintenance organizations, so long as the application in any particular case is in compliance with and is not preempted by applicable federal statutes and regulations. [L 1995, c 179, pt of §1; am L 1998, c 178, §4; am L 2002, c 74, § §4, 6; am L 2003, c 3, §22; am L 2007, c 175, §4; am L 2009, c 11, §54; am L 2011, c 80, §9; am L 2012, c 251, §14; am L 2013, c 56, §2; am L 2014, c 186, §16; am L 2016, c 141, §20]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-20 Filings and reports as public documents.

§432D-20 Filings and reports as public documents.
Notwithstanding chapter 92F and any other laws to the contrary, all applications and filings required under this chapter shall be treated as public, except for trade secrets or privileged or confidential quality assurance, commercial, or financial information; provided that any annual financial statement that may be required under section 432D-5 shall be public. [L 1995, c 179, pt of §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-21 Confidentiality of medical information.

§432D-21 Confidentiality of medical information.
Any data or information pertaining to the diagnosis, treatment, or health of any enrollee or applicant obtained from such person or from any provider by any health maintenance organization shall be held in confidence and shall not be disclosed to any person except to the extent that it may be necessary to carry out the purposes of this chapter, upon the express consent of the enrollee or applicant, pursuant to statute or court order for the production of evidence or the discovery thereof, or in the event of a claim or litigation between such person and the health maintenance organization wherein such data or information is pertinent. A health maintenance organization shall be entitled to claim any statutory privileges against disclosure which the provider who furnished the information to the health maintenance organization is entitled to claim. [L 1995, c 179, pt of §1]
Law Journals and Reviews
Driving into the Sunset: A Proposal for Mandatory Reporting to the DMV by Physicians Treating Unsafe Elderly Drivers. 25 UH L. Rev. 59 (2002).
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-22 Acquisition of control of or merger of a health maintenance organization.

§432D-22 Acquisition of control of or merger of a health maintenance organization.
No person may make a tender for or a request or invitation for tenders of, enter into an agreement to exchange securities for, or acquire in the open market or otherwise, any voting security of a health maintenance organization or enter into any other agreement if, after the consummation thereof, that person, directly or indirectly, or by conversion or by exercise of any right to acquire, would be in control of the health maintenance organization, and no person may enter into an agreement to merge or consolidate with or otherwise to acquire control of a health maintenance organization, unless, at the time any offer, request, or invitation is made or any agreement is entered into, or prior to the acquisition of the securities if no offer or agreement is involved, the person has filed with the commissioner and has sent to the health maintenance organization information required by section 431:11-104 and the offer, request, invitation, agreement, or acquisition has been approved by the commissioner. Approval by the commissioner shall be governed by section 431:11-104(d); provided that if no action is taken by the commissioner within thirty days, the offer, request, invitation, agreement, or acquisition shall be deemed approved. [L 1995, c 179, pt of §1; am L 2000, c 74, §6]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-23 Required provisions and benefits.

§432D-23 Required provisions and benefits.
Notwithstanding any provision of law to the contrary, each policy, contract, plan, or agreement issued in the State after January 1, 1995, by health maintenance organizations pursuant to this chapter, shall include benefits provided in sections 431:10-212, 431:10A-115, 431:10A-115.5, 431:10A-116, 431:10A-116.2, 431:10A-116.5, 431:10A-116.6, 431:10A-119, 431:10A-120, 431:10A-121, 431:10A-122, 431:10A-125, 431:10A-126, 431:10A-132, 431:10A-133, 431:10A-140, and 431:10A-134, and chapter 431M. [L 1995, c 179, pt of §1; am L 1999, c 77, §8 and c 86, §4; am L 2000, c 243, §4; am L 2009, c 168, §3 and c 169, §8; am L 2010, c 157, §3; am L 2012, c 92, §4; am L 2015, c 197, §3, c 213, §5, and c 235, §5; am L 2016, c 204, §4]
Note
Applicability of 2016 amendment. L 2016, c 204, § §6, 8.
Attorney General Opinions
No reference was made to new section added to article 10A of chapter 431 [ §431:10A-601], by §4 of reciprocal beneficiaries act [L 1997, c 383]; thus, §431:10A-601 did not apply to health maintenance organizations. Att. Gen. Op. 97-5.
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-23.6 Federally funded programs; exemption.

§432D-23.6 Federally funded programs; exemption.
Requirements relating to mandated coverages shall not be applicable to any health maintenance organization offering health insurance under a federally funded program under the Social Security Act, as amended; provided that this exemption shall apply only to that part of the health maintenance organization's business under the federally funded program. [L 1999, c 159, §3]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-24 Coordination of benefits.

§432D-24 Coordination of benefits.
(a) Health maintenance organizations are permitted, but not required to adopt provisions for coordination of benefits to avoid overinsurance and to provide for the orderly payment of claims when a person is covered by two or more group health insurance or health care plans.
(b) If health maintenance organizations adopt provisions for coordination of benefits, the provisions must be consistent with the coordination of benefits provisions that are in general use in the State for coordinating coverage between two or more group health insurance or health care plans. [L 1995, c 179, pt of §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-25 Disclosure of health care coverage and benefits.

§432D-25 Disclosure of health care coverage and benefits.
In order to ensure that all individuals understand their health care options and are able to make informed decisions, all health maintenance organizations shall provide current and prospective enrollees with written disclosure of coverages and benefits, including information on coverage principles and any exclusions or restrictions on coverage.
The information provided shall be current, understandable, and available prior to enrollment, and upon request after enrollment. A policy or contract provided to an enrollee which describes coverages and benefits shall be in conformance with part I of article 10 of chapter 431. L 1996, c 274, §3; am L 1999, c 246, §5
Cross References
Patients' bill of rights and responsibilities act, see chapter 432E.
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-26 Genetic information nondiscrimination in health insurance coverage.

§432D-26 Genetic information nondiscrimination in health insurance coverage.
(a) No health maintenance organization 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, and genetic counseling. [L 1997, c 91, §3]
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 › 432D. Health Maintenance Organization Act › 432D-27 Policies relating to domestic abuse cases.

§432D-27 Policies relating to domestic abuse cases.
(a) No health maintenance organization shall deny or refuse to accept an application for insurance, refuse to insure, refuse to renew, cancel, restrict, or otherwise terminate a policy of insurance, or charge a different rate for the same coverage, on the basis that the applicant or enrollee is, has been, or may be a victim of domestic abuse.
(b) Nothing in this section shall prevent a health maintenance organization from taking any of the actions set forth in subsection (a) on the basis of loss history or medical condition, or for any other reason not otherwise prohibited by this section or any other law, regulation, or rule.
(c) Any form filed or filed after July 15, 1998 or subject to a rule adopted under chapter 91 may exclude coverage for losses caused by intentional or fraudulent acts of any enrollee.
(d) Nothing in this section prohibits a health maintenance organization from investigating a claim and complying with chapter 432D.
(e) As used in this section, "domestic abuse" means:
(1) Physical harm, bodily injury, assault, or the infliction of fear of imminent physical harm, bodily injury, or assault between family or household members;
(2) Sexual assault of one family or household member by another;
(3) Stalking of one family or household member by another family or household member;
(4) Intentionally, knowingly, or recklessly causing damage to property so as to intimidate or attempt to control the behavior of another household member; or
(5) Coercive control, as defined in section 586-1, between family or household members. [L 1998, c 171, §5; am L 2004, c 122, §92; am L 2020, c 20, §4]
Revision Note
"July 15, 1998" substituted for "the effective date of this section" pursuant to §23G-15.
2023 Hawaii Revised Statutes › Title 24. Insurance › 432D. Health Maintenance Organization Act › 432D-28 Federal law compliance.

§432D-28 Federal law compliance.
A health maintenance organization 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, §4]