reglab/statecodes huggingface dataset:
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-405 Annual audit.

§432:1-405
Annual audit.
(a) Annually on or before June 1, or such later date as the commissioner upon request or for cause may specify, each domestic mutual benefit society shall file an audit by a designated independent certified public accountant or accounting firm of the financial statements reporting the financial condition and the results of operations of the mutual benefit society. The audited financial statement may use either generally accepted accounting principles (GAAP) or statutory accounting principles (SAP). If the generally accepted accounting principles method is used, a reconciliation of the financial statement to the statutory accounting principles must be provided to the commissioner. The mutual benefit society, 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 mutual benefit society's designation within fifteen days of receipt of the mutual benefit society's notice, and the mutual benefit society shall be required to designate another independent certified public accountant or accounting firm.
(b) The commissioner may suspend or revoke the certificate of authority of any mutual benefit society that fails to file any of the documents required in subsection (a). In lieu of or in addition to suspension or revocation of the certificate of authority of any mutual benefit society, the commissioner may impose on the mutual benefit society a penalty in the amount of not less than $100 and not more than $500 for each day of delinquency. [L 1995, c 110, §1; am L 2012, c 251, §8]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-406 Definitions.

§432:1-406 Definitions.
As used in this article:
"Health care expenditures" means claims incurred.
"Managed hospital payment basis" means agreements wherein the financial risk is primarily related to the degree of utilization rather than to the cost of services.
"Member" means an individual who is covered by a mutual benefit society.
"Net worth" means the excess of total admitted assets over total liabilities, but the liabilities shall not include fully subordinated debt.
"Operating expenses" means claims adjustment, administrative, soliciting, and reinsurance allowances.
"Society" means mutual benefit society.
"Uncovered expenditures" means the costs to the mutual benefit society for health care services that are the obligation of the mutual benefit society, for which a member may be liable in the event of the mutual benefit society's insolvency, and for which no alternative arrangements have been made that are acceptable to the commissioner. Uncovered expenditures include but are not limited to out-of-area services, referral services, and hospital services. Uncovered expenditures do not include expenditures for services when a provider has agreed not to bill the member even though the provider is not paid by the mutual benefit society, or for services that are guaranteed, insured, or assumed by a person or organization other than a mutual benefit society.
[L 1997, c 367, pt of §1; am L 2014, c 186, §13]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-408 Uncovered expenditures insolvency deposit.

§432:1-408
Uncovered expenditures insolvency deposit.
(a) If, at any time, uncovered expenditures exceeds ten per cent of total health care expenditures, a mutual benefit society shall place with the commissioner or with any organization or trustee acceptable to the commissioner through which a custodial or controlled account is maintained, an uncovered expenditures insolvency deposit consisting of cash or securities that are acceptable to the commissioner. The deposit shall have, at all times, a fair market value in an amount of one hundred twenty per cent of the society's outstanding liability for uncovered expenditures for members in this State, including incurred but not reported claims, and shall be calculated as of the first day of the month and maintained for the remainder of the month. If a society is not otherwise required to file a quarterly report, it shall file a report within forty-five days of the end of the calendar quarter with information sufficient to demonstrate compliance with this section.
(b) The deposit required under this section is in addition to the deposit required under section 432:1-407 and is an admitted asset of the mutual benefit society in the determination of net worth. All income from the deposits or trust accounts shall be assets of the society and may be withdrawn from the deposit or account quarterly with the approval of the commissioner.
(c) A mutual benefit society that has made a deposit may withdraw that deposit or any part of the deposit if:
(1) A substitute deposit of cash or securities of equal amount and value is made;
(2) The fair market value exceeds the amount of the required deposit; or
(3) The required deposit under subsection (a) is reduced or eliminated.
Deposits, substitutions, or withdrawals may be made with the prior written approval of the commissioner.
(d) The deposit under this section shall be held in trust and may be used only as provided in this section. The commissioner may use the deposit of an insolvent mutual benefit society for administrative costs associated with administering the deposit and payment of claims of members of this State for uncovered expenditures in this State. Claims for uncovered expenditures shall be paid on a pro rata basis based on assets available to pay such ultimate liability for incurred expenditures. Partial distribution may be made pending final distribution. Any amount of the deposit remaining shall be paid into the liquidation or receivership of the society.
(e) The commissioner may prescribe by rule the time, manner, and form for filing claims under subsection (d).
(f) The commissioner may require by rule or order mutual benefit societies to file annual, quarterly, or more frequent reports as the commissioner deems necessary to demonstrate compliance with this section. The commissioner may require that the reports include liability for uncovered expenditures as well as an audit option.
[L 1997, c 367, pt of §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-409 Rehabilitation, liquidation, or conservation of mutual benefit societies.

§432:1-409 Rehabilitation, liquidation, or conservation of mutual benefit societies.
(a) Any rehabilitation, liquidation, or conservation of a mutual benefit society 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 mutual benefit society 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 society would be hazardous either to the members or to the general public. Members shall have the same priority in the event of liquidation or rehabilitation as the law provides to policyholders of an insurer.
(b) For purposes of determining the priority of distribution of general assets, claims of members and members' beneficiaries shall have the same priority as established by article 15 of chapter 431 for policyholders and beneficiaries of insureds of insurance companies. If a member is liable to any provider for services provided pursuant to and covered by the health care plan, that liability shall have the status of a member claim for distribution of general assets. Any provider who is obligated by statute or agreement to hold members 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 members and members' beneficiaries as described in this subsection, and immediately preceding the priority of distribution described in article 15 of chapter 431.
[L 1997, c 367, pt of §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-410 Reserve credit for reinsurance.

§432:1-410 Reserve credit for reinsurance.
Any society 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, §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-501 Examination by commissioner, assistance of other officers.

§432:1-501 Examination by commissioner, assistance of other officers.
(a) The powers, authorities, and duties relating to examinations vested in and imposed upon the commissioner under article 2 of the insurance code are extended to and imposed upon the commissioner in respect to examinations of mutual benefit societies.
(b) The commissioner in the exercise of any of the commissioner's functions, powers and duties under this article, may use the staff or any members of the staff of the commissioner of financial institutions and may appoint and constitute them as agents for such purpose. [L 1987, c 347, pt of §2; am L 1993, c 350, §19]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-502 Summary orders and supervision.

§432:1-502
Summary orders and supervision.
(a) Whenever the commissioner determines that the financial condition of any mutual benefit society is such that its continued operation might be hazardous to its members, creditors, or the general public, or that it has violated any provision of this chapter, the commissioner, after notice and hearing, may order the society 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 society'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 society of any law of this State to which such society is subject shall be deemed a violation of this chapter.
(c) The commissioner, by rule, may set uniform standards and criteria for early warning that the continued operation of any society might be hazardous to its members, creditors, or the general public and to set standards for evaluating the financial condition of any society, 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 article 15 of chapter 431. [L 1987, c 347, pt of §2; am L 1993, c 350, §20; am L 1997, c 367, §2]
Note
L 1997, c 367, §3 provides:
"SECTION 3. This Act [enacting § §432:1-406 to 409 and amending §432:1-502] shall not apply to:
(1) Societies that do not operate as a hospital, medical or indemnity society, or corporation; and
(2) Labor union mutual benefit societies under section 432:1-103(b)."
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-503 Closing of doors without notice.

§432:1-503 Closing of doors without notice.
If, upon the examination of any society, it is found to be insolvent, or if it is deemed necessary by the commissioner for the protection of the interests of its members or the public, the commissioner may at once close the doors of the society without any notice and take charge of the books, assets and affairs of the society until the appointment of a receiver as provided by law. [L 1987, c 347, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-601 Contract limitations for handicapped children and children with intellectual disabilities.

§432:1-601 Contract limitations for handicapped children and children with intellectual disabilities.
All individual and group hospital or medical service plan contracts, delivered or issued for delivery in this State after May 8, 1968, that provide that coverage of a dependent child shall terminate upon attainment of the limiting age for dependent children specified in the contract shall also provide in substance that attainment of the limiting age shall not operate to terminate the coverage of the child while the child is and continues to be both:
(1) Incapable of self-sustaining employment by reason of intellectual disability or physical handicap; and
(2) Chiefly dependent upon the policyholder, subscriber, or employee, as the case may be, for support and maintenance;
provided that proof of the child's incapacity and dependency is furnished to the hospital service or medical indemnity association by the policyholder, subscriber, or employee within thirty-one days of the child's attainment of the limiting age and subsequently as may be required by the association. [L 1987, c 347, pt of §2; am L 2011, c 220, § §7, 12; am L 2019, c 111, §25]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-602 Newborn children coverage.

§432:1-602
Newborn children coverage.
(a) All individual and group hospital and medical service corporation contracts which provide coverage for a family member of the subscriber shall, as to such family member's coverage, also provide that the benefits applicable for children shall be payable or provided with respect to a newly born child of the subscriber 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 subscription fee or premium is required to provide coverage for the child, the contract may require that notification of birth of a newly born child and payment of the required fee or premium must be furnished to the service corporation within thirty-one days after the date of birth in order to have coverage continue beyond such thirty-one-day period. The requirements of this section shall apply to all subscriber contracts delivered or issued for delivery in this State more than one hundred twenty days after July 1, 1988.
(b) No provision in subsection (a) shall be construed to provide or include coverage for routine well-baby services. [L 1987, c 347, pt of §2]
Revision Note
"July 1, 1988" substituted for "the effective date of this section" pursuant to §23G-15.
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-602.6 Newborn adoptee; coverage.

§432:1-602.6 Newborn adoptee; coverage.
(a) Notwithstanding any provision to the contrary, whenever a policy, contract, plan, or agreement provides coverage for the children of the insured, that coverage shall also extend to the date of birth of any newborn child to be adopted by the insured; provided that the insured gives written notice to the society of the insured's intent to adopt the child prior to the child's date of birth or within thirty days after the child's birth or within the time period required for enrollment of a natural born child under the policy, contract, plan, or agreement of the insured, whichever period is longer; provided, however, if the adoption proceedings are not successful, the insured shall reimburse the society for any expenses paid for the child.
Where notification has not been received by the society prior to the child's birth or within the specified period following the child's birth, insurance coverage shall be effective from the first day following the society's receipt of legal notification of the insured's ability to consent for treatment of the infant whom coverage is sought.
(b) When the insured is a member of a health maintenance organization (HMO), coverage of an adopted newborn is effective:
(1) From the date of birth of the adopted newborn when the newborn is treated from birth pursuant to a provider contract with the health maintenance organization, and written notice of enrollment in accord with the health maintenance organization's usual enrollment process is provided within thirty days of the date the insured notifies the health maintenance organization of the insured's intent to adopt the infant for whom coverage is sought; or
(2) From the first day following receipt by the health maintenance organization of written notice of the insured's ability to consent for treatment of the infant for whom coverage is sought and enrollment of the adopted newborn in accord with the health maintenance organization's usual enrollment process if the newborn has been treated from birth by a provider not contracting or affiliated with the health maintenance organization. [L 1991, c 268, § §2, 5; am L 1995, c 47, §1]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-603 Reimbursement for psychological services.

§432:1-603 Reimbursement for psychological services.
Notwithstanding any provision of any individual or group hospital or medical service plan contract, whenever the contract provides reimbursement or payment for any service which is within the lawful scope of practice of a psychologist licensed in this State, the person entitled to benefits or performing the service shall be entitled to reimbursement or payment whether the service is performed by a licensed physician or licensed psychologist. [L 1987, c 347, pt of §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-604 In vitro fertilization procedure coverage.

§432:1-604 In vitro fertilization procedure coverage.
(a) All individual and group hospital or medical service plan contracts 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 subscriber or member or the subscriber's or member'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 a subscriber or member or covered dependent of the subscriber or member;
(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 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 hospital or medical service plan contracts delivered or issued for delivery in this State after June 26, 1987. [L 1987, c 332, §2 and L 1989, c 276, §4; am L 2003, c 212, §122; am L 2013, c 47, §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-604.5 Contraceptive services.

§432:1-604.5 Contraceptive services.
(a) Notwithstanding any provision of law to the contrary, each employer group health 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, and contraceptive prescription drug coverage 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.
(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 drug or device.
(c) Coverage for 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 a member.
(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 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, §2; am L 1999, c 267, §3; am L 2016, c 141, §18 and c 205, §3; am L 2017, c 67, §4; am L 2019, c 70, §28]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-605 Mammogram screening.

§432:1-605 Mammogram screening.
(a) Notwithstanding any provision to the contrary, each policy, contract, plan, or agreement issued on or after February 1, 1991, except for policies that only provide coverage for specified diseases or other limited benefit coverage, but including policies issued by companies subject to chapter 431, article 10A, part II and chapter 432, article 1 shall provide coverage for screening by low-dose mammography for occult breast cancer as follows:
(1) For women forty years of age and older, an annual mammogram; and
(2) For a woman of any age with a history of breast cancer or whose mother or sister has had a history of breast cancer, a mammogram upon the recommendation of the woman's physician.
(b) The services provided in subsection (a) are subject to any coinsurance provisions that may be in force in these policies, contracts, plans, or agreements.
(c) For purposes of this section, "low-dose mammography" means the x-ray examination of the breast using equipment dedicated specifically for mammography, including but not limited to the x-ray tube, filter, compression device, screens, films, and cassettes, with an average radiation exposure delivery of less than one rad mid-breast, with two views for each breast.
(d) An insurer may provide the services required by this section through contracts with providers; provided that the contract is determined to be a cost-effective means of delivering the services without sacrifice of quality and meets the approval of the director of health. [L 1990, c 112, §3; am L 1994, c 279, §3; am L 1999, c 13, §3]
Note
Director of health to monitor the mammogram screening services to assure that the demand for screening does not exceed the ability of the medical community to safely provide the services. L 1990, c 112, §5.
Cross References
Sunset evaluations modified, see § §26H-4, 26H-5.
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-605.5 Mammograms; referral not required.

§432:1-605.5 Mammograms; referral not required.
(a) For purposes of the annual screening mammogram coverage required under section 432:1-605, no mutual benefit society shall require a covered 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, §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-606 Qualified medical child support order.

§432:1-606 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, §3]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-607 Genetic information nondiscrimination in health insurance coverage.

§432:1-607 Genetic information nondiscrimination in health insurance coverage.
(a) No mutual benefit society 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. [L 1997, c 91, §2]
Law Journals and Reviews
Privacy and Genetics: Protecting Genetic Test Results in Hawai`i. 25 UH L. Rev. 449 (2003).
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-608 Hospice care coverage.

§432:1-608 Hospice care coverage.
(a) Any other law to the contrary notwithstanding, commencing on January 1, 2000, all mutual benefit societies issuing or renewing an individual and group hospital or medical service plan, policy, contract, or agreement in this State that provides for payment of or reimbursement for hospice care shall reimburse hospice care services for each insured member 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 members regarding the coverage required by this section. Notice shall be in writing and in literature or correspondence sent to members, beginning with calendar year 2000, along with any other mailing to members, but in no case later than July 1, 2000. [L 1999, c 77, §5; am L 2011, c 43, §17]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-609 Medical foods and low-protein modified food products; treatment of inborn error of metabolism; notice.

§432:1-609 Medical foods and low-protein modified food products; treatment of inborn error of metabolism; notice.
(a) All individual and group hospital and medical service plan contracts and medical service corporation contracts under this chapter shall provide coverage for medical foods and low-protein modified food products for the treatment of an inborn error of metabolism for its members or dependents of the member 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 mutual benefit society shall provide notice to its members regarding the coverage required by this section. The notice shall be in writing and prominently placed in any literature or correspondence sent to members and shall be transmitted to members during calendar year 2000 when annual information is made available to members, or in any other mailing to members, 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 inherited metabolic disease; 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, §3; am L 2009, c 11, §53]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-610 Federally funded programs; exemption.

§432:1-610 Federally funded programs; exemption.
Requirements relating to mandated coverages shall not be applicable to any mutual benefit society 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 mutual benefit society's business under the federally funded program. [L 1999, c 159, §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-612 Diabetes coverage.

§432:1-612 Diabetes coverage.
All group health care contracts under this chapter shall provide, to the extent provided under section 431:10A-121, coverage for outpatient diabetes self-management training, education, equipment, and supplies. [L 2000, c 243, §3]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-615 Primary care provider; advanced practice registered nurse.

§432:1-615 Primary care provider; advanced practice registered nurse.
(a) Each policy of insurance delivered or issued for delivery in this State by a mutual benefit society 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, §3]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-616 Cancer treatment.

§432:1-616 Cancer treatment.
(a) All individual and group hospital and medical service plan contracts 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 hospital and medical service plan contracts 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, §2; am L 2012, c 30, §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-617 Colon cancer screening coverage.

§432:1-617 Colon cancer screening coverage.
(a) All individual and group hospital and medical service contracts providing health care 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 of 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, §2]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-618 Human immunodeficiency virus and acquired immunodeficiency syndrome screening coverage.

§432:1-618 Human immunodeficiency virus and acquired immunodeficiency syndrome screening coverage.
(a) Each hospital or medical service plan contract issued or renewed in this State, except for plan contracts that only provide coverage for specified diseases or other limited benefit coverage, shall provide coverage for annual screenings for sexually transmitted diseases, including screenings for human immunodeficiency virus and acquired immunodeficiency syndrome.
(b) Each mutual benefit society 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, §3]
Note
Applicability of section. L 2016, c 204, § §6, 8.
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-620 Formulary; accessibility requirements.

§432:1-620 Formulary; accessibility requirements.
(a) Each mutual benefit society offering or renewing an individual and group hospital or medical service plan contract 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 mutual benefit society'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 a subscriber or potential subscriber 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 a subscriber of each specific drug included on the formulary based on the information the mutual benefit society 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, §2; am L 2019, c 70, §33]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-621 Medication synchronization; proration; dispensing fees.

§432:1-621
Medication synchronization; proration; dispensing fees.
(a) Each hospital or medical service plan contract that provides prescription drug coverage in the State shall apply a prorated daily cost-sharing rate to prescriptions that are dispensed by a network pharmacy for less than a thirty-day supply for the purpose of medication synchronization; provided that the member patient requests or agrees to less than a thirty-day supply.
(b) For the purposes of medication synchronization under this section, the mutual benefit society that provides prescription drug coverage shall:
(1) Not deny coverage for the dispensing of a maintenance medication that is dispensed by a network pharmacy on the basis that the dispensed amount is a partial supply and the member patient requests or agrees to a partial supply; and
(2) Authorize a network pharmacy to override any denial codes indicating that a prescription is being refilled too soon.
(c) No plan contract providing prescription drug coverage shall use payment structures incorporating prorated dispensing fees. Dispensing fees for partially filled or refilled prescriptions shall be paid in full for each prescription dispensed, regardless of any prorated copayment for the beneficiary or fee paid for medication synchronization services.
(d) A network pharmacy shall identify an anchor prescription to which all other prescriptions may be subject to medication synchronization; provided that any medication dispensed in an unbreakable package shall not be considered the anchor prescription for purposes of this section.
(e) No schedule II narcotic controlled substance listed in section 329-16 shall be eligible for medication synchronization.
(f) For purposes of this section:
"Medication synchronization" means the coordination of medication refills that are being dispensed by a single contracted pharmacy to a member patient taking two or more medications for one or more chronic conditions so that the patient's medications are refilled on the same schedule for a given time period.
"Unbreakable package" means a medication form or package that is to be dispensed in its original container. The term "unbreakable package" includes but is not limited to eye drops, inhalers, creams, and ointments. [L 2018, c 197, §3]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-622 Extension of dependent coverage.

§432:1-622 Extension of dependent coverage.
Each individual or group hospital or medical service plan contract and each mutual benefit society offering individual or group hospital or medical service plan contracts that provide 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 plan contract to make coverage available for a child of a child receiving dependent coverage. [L 2018, c 111, pt of §4]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-623 Prohibition of preexisting condition exclusions.

§432:1-623 Prohibition of preexisting condition exclusions.
(a) No individual or group hospital or medical service plan contract issued or renewed in this State shall impose any preexisting condition exclusion.
(b) For purposes of this section, a "preexisting condition exclusion" means a limitation or exclusion of benefits, including a denial of coverage, based on the fact that the condition was present before the effective date of coverage (or if coverage is denied, the date of the denial) under an individual or group hospital or medical service plan contract, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before that day and includes any condition.
The term "preexisting condition exclusion" includes any limitation or exclusion of benefits, including a denial of coverage, applicable to an individual as a result of information relating to an individual's health status before the individual's effective date of coverage (or if coverage is denied, the date of the denial) under an individual or group hospital or medical service plan contract, 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 §4]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-624 Prohibited discrimination in premiums or contributions.

§432:1-624 Prohibited discrimination in premiums or contributions.
No individual or group hospital or medical service plan contract and no mutual benefit society offering individual or group hospital or medical service plan contracts issued or renewed in this State shall require an individual, as a condition of enrollment or continued enrollment under the plan contract, 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 plan contract or a substantially similar plan contract offered by the same mutual benefit society. [L 2018, c 111, pt of §4]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:1-625 Reimbursement to providers.

§432:1-625 Reimbursement to providers.
(a) Coverage for services required by this part shall include reimbursement to health care providers who perform services required by this article, or to the insured member, as appropriate.
(b) Whenever an individual or group policy, contract, plan, or agreement that provides health care coverage under this article 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" has the same meaning as in section 431:10A €“144(c). [L 2019, c 70, §4]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:2-101 Scope of article.

§432:2-101 Scope of article.
This article relates only to fraternal benefit societies, as defined herein, which desire to be authorized to pay benefits in accordance with this article after July 10, 1961. This article shall not apply to legal service plans subject to chapter 488 even though the plan may be offered by a fraternal benefit society. [L 1987, c 347, pt of §2; am L 2012, c 34, §24]
2023 Hawaii Revised Statutes › Title 24. Insurance › 432. Benefit Societies › 432:2-102 Applicability of other laws.

§432:2-102
Applicability of other laws.
(a) Except as herein provided, societies shall be governed by this article and shall be exempt from all other provisions of the insurance laws of this State unless they are expressly designated therein, or unless it is specifically made applicable by this article.
(b) Nothing in this article shall exempt fraternal benefit societies from the provisions and requirements of part IV of article 2, part IV of article 3, and article 15 of chapter 431, and sections 431:2-215, 431:3-303, 431:3-304, and 431:3-305. [L 1987, c 347, pt of §2; am L 2000, c 182, §15; am L 2009, c 149, §5; am L 2011, c 80, §8; am L 2014, c 186, §14]