reglab/statecodes huggingface dataset:
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 13 - THE JOINT UNDERWRITING PLAN › Section 16-23-67 - General description

Current through June, 2024
(a) The joint
				underwriting plan (JUP) is intended to provide motor vehicle insurance and
				optional additional insurance in a convenient and expeditious manner for those
				persons, uses, or motor vehicles in certain "high risk" categories with respect
				to which insurance cannot reasonably be obtained in the market at rates not in
				excess of JUP rates, or persons who otherwise are in good faith entitled to,
				but unable to obtain, motor vehicle insurance and optional additional insurance
				through ordinary methods. Insurers will pool their losses and bona fide
				expenses under JUP to prevent the imposition of any inordinate burden on any
				particular insurer.
(b) Another
				part of the JUP consists of the assignment thereto of claims of victims for
				whom no policy is applicable, such as the hit-and-run victim who is not covered
				by a motor vehicle insurance policy. The losses and expenses under the assigned
				claims program are pro-rated among and shared by all motor vehicle insurers and
				self-insurers.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 13 - THE JOINT UNDERWRITING PLAN › Section 16-23-68 - Membership in JUP

Current through June, 2024
(a) Each insurer shall be a member of the
				JUP. As a condition of licensure it shall:
(1) Maintain its membership at a minimum fee
				of $1,000 per year or part thereof; and
(2) Accept appointment as a servicing carrier
				if the commissioner finds it necessary in the public interest and that the
				insurer is capable of performing as a servicing carrier.
This section shall not apply to those insurers writing motor
				  vehicle insurance exclusively under section
				  431:10C-106,
				  HRS.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 13 - THE JOINT UNDERWRITING PLAN › Section 16-23-70 - Allocation of JUP costs

Current through June, 2024
All costs incurred in the operation of the joint
				  underwriting plan bureau and the operation of the plan, such as administrative,
				  staff, and claims (other than assigned claims) paid, shall be allocated fairly
				  and equitably among the JUP members.
The allocations shall be computed on a "share of the
				  voluntary market" basis.
Allocation of private passenger non-fleet experience will be
				  on the basis of net direct written car years.
Allocation of commercial and all other experience will be on
				  the basis of net direct written premiums.
Member insurers or the statistical agencies designated by
				  them shall report all of the data necessary to comply with the allocation
				  procedures to the commissioner or agent designated by the commissioner. Each
				  insurer shall permit its statistical agent to release such data to the
				  commissioner or agent designated by the commissioner.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 13 - THE JOINT UNDERWRITING PLAN › Section 16-23-71 - Selection of servicing carriers

Current through June, 2024
The commissioner shall select certain insurers as servicing
				  carriers, who will provide JUP coverage and perform direct insurance operations
				  on behalf of JUP members. In making the selection, the commissioner shall
				  consider:
(1) Whether the carrier is
				able to process and maintain a high level of service for all risks submitted
				through agents;
(2) Whether it has
				the facilities to provide JUP policyholders and assigned claimants a high level
				of service;
(3) Whether it is able
				to service private passenger or commercial lines and to process fluctuating
				work volumes and maintain quality of service through peak periods;
(4) Whether its claims service is adequate,
				including an adequately decentralized adjusting staff, a claims examining staff
				resident in Hawaii, and local authority to settle claims at least up to the
				statutory basic motor vehicle insurance limits; and
(5) Whether it is capable of producing
				accounting and statistical reports and other data as required.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 13 - THE JOINT UNDERWRITING PLAN › Section 16-23-72 - Classifications eligible for JUP

Current through June, 2024
(a) In addition to
				the classifications established in section
				431:10C-407, HRS,
				the JUP shall provide motor vehicle insurance policies for the following
				classes of persons, motor vehicles, and uses:
(1) Motor vehicles owned by licensed drivers,
				defined as follows:
(A) The applicant or any
				person who resides in the same household as the applicant and customarily
				operates the automobile or any other person who regularly and frequently
				operates the motor vehicle to be insured, who:
(i) Within thirty-six months prior to the
				date of the application has been convicted of operating a motor vehicle without
				motor vehicle insurance;
(ii)
				Within the eighteen months prior to the date of the application, has been
				convicted of or forfeited bail for two or more moving traffic violations;
				or
(iii) Has been convicted of any
				felony involving a motor vehicle;
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 13 - THE JOINT UNDERWRITING PLAN › Section 16-23-74 - Application for JUP, placement; reporting disposition

Current through June, 2024
A person may apply for coverage under the JUP to any motor
				  vehicle insurance producer who shall inform the applicant whether or not the
				  applicant is eligible for JUP coverage.
Any eligible certified public assistance insured (CPAI)
				  shall apply for motor vehicle insurance coverage directly to the servicing
				  carrier of the insured's choice.
If the applicant qualifies for and desires JUP coverage, a
				  producer who represents servicing carriers in the voluntary market shall use
				  these servicing carriers in placing JUP applications, giving preference to the
				  applicant's choice. A producer who does not represent any servicing carrier in
				  the voluntary market may place the JUP insurance with an appropriate servicing
				  carrier, giving preference to the applicant's choice. A producer licensed to
				  write motor vehicle insurance shall automatically be licensed and authorized to
				  bind eligible applicants on behalf of the JUP and shall communicate the fact of
				  such binding directly to the affected servicing carrier.
A producer shall inform the commissioner in writing of each
				  application for JUP coverage received by it, showing the disposition thereof,
				  i.e., whether the application was denied (and the reason therefor) or approved,
				  and if approved, the servicing carrier with which the application was placed -
				  within two working days after the date of disposition. The commissioner may
				  inquire into the propriety of any disposition and when indicated by the
				  circumstances may, after affording the applicant, insurer, and any other
				  affected persons an opportunity to be heard, take such action as may be
				  appropriate.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 13 - THE JOINT UNDERWRITING PLAN › Section 16-23-75 - Denial of application; appeal

Current through June, 2024
If an insurer denies an applicant JUP coverage under section
				  16-23-72(a)(1) or
				  (a)(2) or section
				  431:10C-407, HRS,
				  the insurer, by the next working day, shall mail or deliver to the applicant in
				  triplicate a notice of the denial, of the applicant's right to appeal, and of
				  the appeal procedure. If the applicant desires a review of the denial of the
				  application, the applicant shall file with the commissioner two copies of the
				  notice of denial, a request for review, and a statement in duplicate giving the
				  applicant's reasons for the request within seven calendar days after the date
				  of denial of the application.
The commissioner shall forthwith notify the insurer of the
				  request for review, enclosing a copy of the statement of reasons
				  therefor.
The appeal shall be heard and determined in accordance with
				  the provisions of chapter
				  91, HRS, and chapter 16-201.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 13 - THE JOINT UNDERWRITING PLAN › Section 16-23-76 - Administration by JUP bureau

Current through June, 2024
If the commissioner determines that the method of assignment
				  of JUP applicants described herein is not operating in an effective and fair
				  manner, the commissioner may have the JUP bureau directly receive, assign, and
				  supervise the servicing of all applications for JUP coverage.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 13 - THE JOINT UNDERWRITING PLAN › Section 16-23-77 - Servicing carriers' duties

Current through June, 2024
A servicing carrier shall:
(1) Accomplish confirmation of rating
				criteria, such as an applicant's or policyholder's driving record;
(2) Issue insurance policies and
				endorsements, and certify the eligibility certificates within fifteen working
				days after receipt of an application for JUP coverage;
(3) Effectively and efficiently perform all
				necessary accounting and statistical procedures set forth in the JUP
				manual;
(4) Collect the necessary
				data to disburse commission payments to producers and be able to store the data
				and transmit it to the Internal Revenue Service annually; and
(5) Account to the commissioner as required,
				and take such action as the commissioner may properly require.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 13 - THE JOINT UNDERWRITING PLAN › Section 16-23-78 - Allowances to servicing carriers

Current through June, 2024
Servicing carriers shall be reimbursed for their servicing
				  expenses on the basis of:
(1)
				Non-CPAI:
(A) Ten per cent of written premium
				for operating costs, excluding claims expense, plus;
(B) Twelve per cent of earned premium for the
				reporting period for loss adjustment expenses, both allocated or direct and
				unallocated or indirect, for liability coverage; and
(C) Ten per cent of earned premium for the
				reporting period for physical damage coverages;
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 13 - THE JOINT UNDERWRITING PLAN › Section 16-23-79 - Commissions

Current through June, 2024
A servicing carrier shall pay a producer for business
				  written pursuant to the JUP a commission at the following rate:
(1) For private passenger non-fleet motor
				vehicle insurance, a commission of eight per cent of the written premium up to
				a maximum amount of $75 per vehicle for all new business and five per cent of
				the written premium up to a maximum amount of $35 per vehicle for all
				renewals;
(2) For commercial and
				all other vehicles, five per cent of written premium for all new business and
				renewals; and
(3) No commission
				shall be paid for CPAI business.
All risks transferred from one servicing carrier to another
				  under the JUP or reinstated policies are to be considered renewal
				  business.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 13 - THE JOINT UNDERWRITING PLAN › Section 16-23-80 - JUP rates

Current through June, 2024
The commissioner shall establish rating rules, refinement of
				  classifications, rates, rating plans, territories, and policy forms for use
				  under the JUP after consultation with the JUP board of governors and in
				  accordance with the requirements and standards prescribed in sections
				  431:10C-409
				  through
				  431:10C-412,
				  HRS.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 13 - THE JOINT UNDERWRITING PLAN › Section 16-23-81 - JUP private passenger manual

Current through June, 2024
The private passenger manual of the Hawaii joint
				  underwriting plan (HJUP) and any amendments approved by the commissioner,
				  published by the Automobile Insurance Plans Service Office (Rhode Island), is
				  adopted as the private passenger automobile manual of the HJUP. Copies of the
				  HJUP private passenger automobile manual are available at the Automobile
				  Insurance Plans Service Office (Rhode Island), and are available for inspection
				  at the insurance division, department of commerce and consumer affairs. The
				  private passenger manual may be combined with the commercial manual to produce
				  one manual.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 13 - THE JOINT UNDERWRITING PLAN › Section 16-23-82 - JUP commercial manual

Current through June, 2024
The commercial automobile manual of the Hawaii joint
				  underwriting plan (HJUP) and any amendments approved by the commissioner,
				  published by the Automobile Insurance Plans Service Office (Rhode Island), is
				  adopted as the commercial automobile manual of the HJUP. Copies of the HJUP
				  commercial automobile manual are available at the Automobile Insurance Plans
				  Service Office (Rhode Island), and are available for inspection at the
				  insurance division, department of commerce and consumer affairs. The commercial
				  manual may be combined with the private passenger manual to produce one
				  manual.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 13 - THE JOINT UNDERWRITING PLAN › Section 16-23-84 - JUP assigned claims; application; and assignment of claims

Current through June, 2024
The claimant shall apply to the JUP bureau, which shall
				  promptly assign the claim to an appropriate servicing carrier and notify the
				  claimant thereof. The assignment shall be made so as to minimize inconvenience
				  to the claimant. The claimant and the assignee carrier shall have rights and
				  obligations as set forth in part II of chapter
				  431:10C, HRS.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 13 - THE JOINT UNDERWRITING PLAN › Section 16-23-85 - Proration of costs and assigned claims paid

Current through June, 2024
The commissioner shall annually prorate among and assess all
				  insurers and self-insurers all costs and claims paid under the assigned claims
				  program.
Proration shall be based upon a pro rata distribution for
				  each premium dollar actually or theoretically received. A self-insurer shall be
				  assessed that prorated amount based upon the total premium cost for the
				  coverage and vehicles stated in its certificate of self-insurance, as if the
				  self-insurer had sold such coverage at JUP premium rates.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 13 - THE JOINT UNDERWRITING PLAN › Section 16-23-86 - JUP membership termination

Current through June, 2024
A member may terminate membership in the JUP upon
				  termination of its licensure to transact motor vehicle insurance business in
				  this State. With respect to all policies in effect on the effective date of a
				  member's termination, the liability of the terminating member shall cease on
				  the anniversary date of each policy during the succeeding year. Termination of
				  membership shall not discharge or otherwise affect liabilities incurred prior
				  to the expiration of these policies and the member shall continue to pay
				  assessments until its proportionate share established by its writings prior to
				  discontinuance of business has been determined. However, if the motor vehicle
				  liability, personal injury protection, or physical damage business of an
				  insurer discontinuing the writing of motor vehicle liability, personal injury
				  protection, or physical damage insurance in this State has been purchased by,
				  transferred to, or reinsured by another insurer, the latter shall pay the
				  assessments of the former until the proportionate share of the former as
				  established by its writings prior to such transfer has been paid.
In the event that an insurer is merged with another insurer
				  or there is a consolidation of insurers, the continuing insurer shall pay the
				  assessments of the insurer merged or consolidated. Groups of insurers under the
				  same ownership and management shall be treated as a single insurer under these
				  provisions. Groups of insurers under either the same ownership or management,
				  but not both, may elect to be treated separately.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 13 - THE JOINT UNDERWRITING PLAN › Section 16-23-87 - Joint liability for JUP business

Current through June, 2024
In the event of the failure of any member, through
				  insolvency or otherwise, to pay promptly its portion of any loss or expense,
				  after the JUP has made written demand upon it to pay the loss or expense, the
				  commissioner shall take appropriate action. If the loss or expense remains
				  unpaid beyond a reasonable period, all of the other motor vehicle insurance
				  insurers, upon notification by the commissioner shall promptly pay their
				  respective pro rata shares, based upon the predetermined participation ratios.
				  Members which have made contributions shall have the right to recovery
				  thereafter against the member in default, provided, that the commissioner may
				  enter into an agreement with the member in default, or with its legal
				  representative, upon an amount which shall constitute a full settlement of all
				  of the obligations of the member to the remaining members.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 13 - THE JOINT UNDERWRITING PLAN › Section 16-23-88 - Auditing of members

Current through June, 2024
The commissioner may audit the records of any member
				  relating to the JUP and may prescribe policies, and the keeping of records,
				  books of account, documents, and related material that the commissioner deems
				  necessary to carry out JUP functions. This material shall be provided by the
				  members in the form and with the frequency required by the
				  commissioner.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 15 - MOTOR VEHICLE INSURANCE ADMINISTRATION REVOLVING FUND › Section 16-23-91 - Allocation of cost of motor vehicle insurance administration

Current through June, 2024
(a)
				Each insurer authorized to transact motor vehicle insurance in this State shall
				be assessed by the commissioner an amount computed on the basis of the motor
				vehicle insurance premiums written in this State by the insurer during the
				previous calendar year. Each self-insurer shall be assessed based upon the
				total premium cost for the coverage and vehicles stated in its certificate of
				self-insurance as if the self-insurer had sold the coverage at the premium
				rates applicable under the
Hawaii Joint Underwriting Plan. Annually, on April 1 of each
				  year, the commissioner shall determine the amounts due based on the amount
				  needed for that year to administer the commissioner's obligations under article
				  10C of chapter
				  431, HRS. The commissioner shall give
				  written notice to each insurer authorized to write motor vehicle insurance in
				  this State and each self-insurer. The amounts required by this subsection shall
				  be due on September 1 of each year.
(b) The commissioner may pay out of the motor
				vehicle insurance administration revolving fund moneys to cover the cost of
				administering article 10C of chapter 431, HRS, as described in section
				431:10C-115.5, HRS[,
				and 1997 SLH, Act 251].
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 17 - FEE SCHEDULE AND UTILIZATION GUIDELINES › Section 16-23-93 - Fee schedules

Current through June, 2024
Subject to the time limitations set forth in section
				  431:10C-315,
				  HRS, this subchapter shall apply to treatment occurring after May 31, 1993.
				  Charges and treatment rendered for emergency services during the initial
				  seventy-two hours following the motor vehicle accident resulting in injury
				  shall not be subject to this subchapter; provided, however, that charges for
				  emergency treatment shall not exceed the health care or alternative care
				  provider's usual and customary fee and shall be appropriate, reasonable, and
				  necessarily incurred. Charges for treatment of a primarily palliative nature
				  shall be subject to the requirements of this subchapter in the same manner as
				  any other treatment.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 17 - FEE SCHEDULE AND UTILIZATION GUIDELINES › Section 16-23-94 - Definitions

Current through June, 2024
As used in this subchapter:
"Claimant" means a person entitled to the benefits described
				  in section
				  431:10C-103.5,
				  HRS, under a motor vehicle insurance policy.
"Emergency treatment" or "emergency services" means
				  treatment or services which are performed within the initial seventy-two hours
				  following the motor vehicle accident because the condition is life threatening
				  or could cause serious harm.
"Physician" includes a doctor of medicine, a dentist, a
				  chiropractor, an osteopath, a psychologist, an optometrist, and a
				  podiatrist.
"Specialist" means a physician or surgeon who holds a
				  certificate as a diplomate issued by a specialty board approved by the American
				  Medical Association or the American Dental Association.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 17 - FEE SCHEDULE AND UTILIZATION GUIDELINES › Section 16-23-99 - Concurrent treatment

Current through June, 2024
(a) Concurrent
				treatment by more than one health care or alternative care provider may be
				allowed if the attending health care provider determines the claimant's injury
				involves more than one body system, and requires multidiscipline care, or is so
				severe or complex that services of more than one health care or alternative
				care provider are required.
(b)
				Whenever a request for concurrent treatment is submitted, the insurer shall
				respond within five working days after postmark of such request, giving
				authorization or stating in writing the reason for refusal to each attending
				health care provider and the claimant. Any such refusal shall be filed
				concurrently with the commissioner. Failure by the insurer to respond within
				five working days after postmark of the request shall constitute approval of
				the request.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 17 - FEE SCHEDULE AND UTILIZATION GUIDELINES › Section 16-23-100 - Change in health care or alternative care providers

Current through June, 2024
The application of the frequency of treatment guidelines set
				  forth in this subchapter shall not be affected when the claimant changes the
				  health care or alternative care provider. If a claimant receives treatments in
				  excess of those specified in the guidelines, regardless of whether the
				  treatments are performed by one health care or alternative care provider or by
				  more than one health care or alternative care provider, the excess treatments
				  may be subject to prior authorization.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 17 - FEE SCHEDULE AND UTILIZATION GUIDELINES › Section 16-23-103 - Rules of decision for allowable fees for medical, surgical, and hospital services and supplies

Current through June, 2024
(a) When all the
				required care for a case reasonably falls within the range of qualifications of
				one health care provider, no other health care provider may claim a fee, except
				for consultation service or for surgical assistance. For groups of health care
				providers or hospitals with satellite clinics, when service is rendered by a
				group member of the same specialty, the group shall submit bills as though one
				health care provider had cared for the claimant.
(b) Medical, surgical, or hospital care of an
				unusual type or unlisted fee may occur which represents a type of service over
				and beyond listed procedures. Appropriate fees may be allowed if the treatment
				was reasonable, appropriate, and necessary.
(c) Medical conditions or symptoms which are
				pre-existing and are not aggravated or affected by and do not result from the
				injury covered by motor vehicle insurance benefits shall not be compensable.
				Palliative treatment of these unrelated conditions shall be allowed, provided
				that these conditions directly retard, prevent, or endanger the surgical care
				or recovery from the injury covered by motor vehicle insurance benefits. In
				addition, pre-existing conditions which did not require treatment before the
				motor vehicle accident resulting in accidental harm but which do require
				treatment as a result of the accident shall be compensable. Pre-existing
				conditions which required treatment at the time of the accident and which are
				aggravated or affected so as to require additional treatment shall be
				compensable to the extent of the additional treatment.
(d) Certain of the procedures listed in
				medical fee schedules are commonly carried out as an integral part of a total
				service and do not warrant a separate charge. When such a procedure is carried
				out as a separate procedure, not immediately related to other services, the
				indicated fee is applicable.
(e)
				Minimal dressings, counseling incidental to treatment, etc., are covered by the
				office visit fee. Necessary drugs, supplies, and materials provided by the
				health care provider may be charged for separately in accordance with section
				16-23-114.
(f) Fees including office visits shall not be
				paid for more than one visit per day by the same health care provider of
				service regardless of the number of injuries or conditions treated.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 17 - FEE SCHEDULE AND UTILIZATION GUIDELINES › Section 16-23-104 - Health care providers

Current through June, 2024
(a) Frequency and
				extent of treatment shall not be more than the nature of the injury and the
				process of recovery requires. Authorization is not required for the initial
				fifteen treatments of the injury during the first sixty calendar days, except
				for naturopathic, chiropractic and acupuncture treatments which are governed by
				section
				431:10C-103.6,
				HRS.
(b) A bill for no more than
				four hours for psychometric, projective, and other psychological testing and
				the resultant reports shall not be subject to prior authorization.
(c) Conservative care extending beyond one
				hundred twenty calendar days from the date of first treatment may be subject to
				prior authorization.
(d)
(1) If the injury is the result of an
				accident on or after January 1, 1998, chiropractic and acupuncture visits shall
				be limited to the number of and costs for treatments in section
				431:10C-103.6,
				HRS.
(2) A "visit" shall include
				all examinations or chiropractic manipulative treatments involving one or more
				regions, spinal, and authorized physiotherapy modalities and procedures or
				acupuncture treatments provided on the same date.
(3) The Hawaii state chiropractic guidelines
				are those guidelines in effect on January 25, 1997 (light green
				cover).
(4) Payments to a
				chiropractor or an acupuncturist for visits shall conform to paragraph (1) and
				shall not be reduced or revised by an insurer or its agent(s).
(5) Chiropractic treatments shall not exceed
				the scope of practice permitted by chapters
				431 and
				442, HRS.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 17 - FEE SCHEDULE AND UTILIZATION GUIDELINES › Section 16-23-106 - Physician assistants

Current through June, 2024
Attending health care providers may prescribe treatment in
				  their discipline to be carried out by persons certified or licensed to provide
				  the service. Fees for services provided by certified or licensed physician
				  assistants under Hawaii law shall be sixty per cent of the fees authorized by
				  section 16-23-115. Fees for services
				  provided by assistants not certified or licensed shall be fifty per cent of the
				  fees authorized by section
				  16-23-115.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 17 - FEE SCHEDULE AND UTILIZATION GUIDELINES › Section 16-23-110 - Anesthesia services

Current through June, 2024
(a) A base unit is
				listed for all procedures in the medical fee schedule in accordance with
				section
				16-23-115.
				This includes the base unit of all anesthesia services except the value of the
				actual time spent administering the anesthesia or in unusual detention with the
				patient.
(b) As allowed under
				Medicare, the anesthesia charges are equal to the sum of the base and time
				units for the service multiplied by a geographical adjusted anesthesia-specific
				conversion factor.
(c) The total
				value for anesthesia services includes pre- and post-operative visits, the
				administration of the anesthetic, and the administration of fluids and blood
				incident to the anesthesia or surgery.
(d) The time units are computed by dividing
				the total anesthesia time by fifteen minutes.
(e) Calculated values for anesthesia services
				shall be used when the anesthesia is administered by an appropriately licensed
				health care provider and a fee shall be paid only for the individual anesthetic
				service.
(f) If the general or
				regional anesthetic is administered by the attending health care provider, the
				value shall be fifty per cent of the calculated value.
(g) A separate charge may be made for
				necessary drugs and materials provided by the health care provider or
				anesthetist in accordance with section
				16-23-114.
(h) When unusual detention with the claimant
				is essential for the safety and welfare of the claimant, the necessary time
				will be valued on the same basis as indicated for anesthesia time.
(i) No additional fee shall be allowed for
				local infiltration or digital block anesthesia administered by the operating
				physician.
(j) When either a
				hypothermia or a pump oxygenator, or both, are employed in conjunction with an
				anesthetic, the anesthetic "basic" value will be equal to that of procedure
				code 00560.
(k) Where anesthesia is
				administered for dental services, if the above rules are not applicable, a fee
				equal to that of the procedure code 00122 for inhalation anesthesia and equal
				to that of procedure code 00102 by an intravenous route will be allowed.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 17 - FEE SCHEDULE AND UTILIZATION GUIDELINES › Section 16-23-111 - Radiology services

Current through June, 2024
(a) Taking of
				anterior-posterior (A-P), lateral, and oblique x-rays shall be discretionary
				for one hundred-twenty days following the initial treatment and may be allowed
				without authorization. Prior authorization from the insurer shall be obtained
				for x-rays subsequent to the initial one hundred-twenty days of
				treatment.
(b) Diagnostic tests and
				x-rays shall be taken, reported, and marked for identification and orientation
				in accordance with the accepted standard of radiologic practice. X-rays shall
				be taken on machines with a current certification by the department of
				health.
(c) Where contrast x-ray
				examinations are performed, fees shall include the usual contrast media. When
				special trays or materials are provided by the health care provider, rather
				than by the hospital, an additional charge is warranted.
(d) Injection procedures, including major
				surgery, for the purpose of performing needed radiological studies, are covered
				in the section on surgery. The fee shall be paid to the health care provider
				actually performing the service.
(e) Fees shall include both the technical and
				professional components. In the absence of any prior agreement between a
				radiologist and a hospital or other facility furnishing technical radiology
				services, the professional component shall be thirty-five per cent of the
				scheduled radiology fee. The technical (-TC) and professional (-26) components
				may be billed separately using the appropriate modifiers as indicated by
				Medicare. Billings for x-rays are not reimbursable without a report of the
				findings.
(f) Radiotherapy includes
				the use of x-ray and other high energy modalities (betatron, linear
				accelerator, etc.), radium cobalt, and other radioactive substances. Fees for
				therapy include follow-up care, and concomitant office visits, but not
				concomitant surgical, radiological, or laboratory procedures.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 17 - FEE SCHEDULE AND UTILIZATION GUIDELINES › Section 16-23-113 - Hospital services

Current through June, 2024
(a) Subject to the
				terms of the motor vehicle insurance policy, when hospitalization is required
				for further treatment of a claimant, that claimant shall have a free choice of
				a licensed hospital in the county where the injury occurred or in the county
				where the claimant resides. If the claimant is in critical condition or unable
				to express a choice, then the attending health care provider may designate the
				hospital to which the claimant will be taken.
(b) Hospital charges shall be limited to ward
				rates or the lowest prevailing rate at the hospital where the claimant is
				confined, except if the nature of the injury requires private care, intensive
				care, or isolation, as determined by the attending health care provider, in
				which case the prevailing private rates may be charged.
(c) When a claimant is treated in the
				emergency facility of a hospital, the allowable hospital charge for the use of
				the emergency room shall be the established emergency room charge for that
				particular hospital.
(d) All
				hospital charges shall be itemized when a bill is submitted.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 17 - FEE SCHEDULE AND UTILIZATION GUIDELINES › Section 16-23-114 - Drugs, supplies and materials

Current through June, 2024
(a) All charges for
				prescribed drugs, supplies, or materials for the use of the claimant shall be
				separately listed and certified by the health care provider, or a duly
				authorized representative that the charges for the drugs, supplies, or
				materials were required or prescribed for the injury covered by motor vehicle
				insurance benefits.
(b) Dietary
				supplements such as minerals and vitamins shall not be reimbursable unless a
				specific compensable dietary deficiency has been clinically established in the
				claimant as a result of the injury covered by motor vehicle insurance
				benefits.
(c) Payment for covered
				prescription drugs and supplies shall be made at the average wholesale price
				plus forty per cent of the average wholesale price when sold by a health care
				provider, hospital, pharmacy, or alternative health care provider of service.
				Billings for prescriptive drugs shall include the national drug code number
				listed in the current American Druggist Red Book followed by the average
				wholesale price listed at time of purchase by the health care provider of
				service. Approved generics shall be substituted for brand name pharmaceuticals
				unless the prescribing health care provider certifies no substitution is
				permitted because the claimant's condition will not tolerate a generic
				preparation.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 23 - MOTOR VEHICLE INSURANCE LAW › Subchapter 17 - FEE SCHEDULE AND UTILIZATION GUIDELINES › Section 16-23-115 - Workers' compensation medical fee schedule

Current through June, 2024
(a) Charges
				for medical services shall not exceed one hundred ten per cent of participating
				fees prescribed in the Medicare Resource Based Relative Value Scale System
				applicable to Hawaii (Medicare Fee Schedule) or Exhibit A at the end of Title
				12, Chapter
				15, entitled "Workers' Compensation
				Supplemental Medical Fee Schedule" (Exhibit A). The Medicare Fee Schedule and
				Exhibit A, together herein referred to as the "medical fee schedule," is made a
				part of this chapter and shall be used to determine the maximum allowable fees
				using the procedure codes and unit values established by the department of
				labor and industrial relations pursuant to section
				386-21,
				HRS. Any subsequent amendment by the department of labor and industrial
				relations to the Medicare fee schedule and Exhibit A, shall be incorporated
				into this chapter by reference.
(b)
				If the maximum allowable fees for medical services are listed in both the
				Medicare Fee Schedule and Exhibit A, charges shall not exceed the maximum
				allowable fees allowed under Exhibit A.
(c) For the purposes of this section "private
				patient" means a patient not covered by insurance. If the charges are not
				listed in the medical fee schedule or in Exhibit A, the health care provider
				shall charge a fee not to exceed eighty per cent of the health care or
				alternative care provider's usual and customary fee for the same service
				rendered to a private patient. Upon request by the insurer, a health care or
				alternative care provider shall submit a statement itemizing the lowest fee
				charged for the same health care, services, and supplies furnished to any
				private patient during a one-year period preceding the date of the particular
				charge. Requests shall be submitted in writing within twenty calendar days of
				receipt of a charge allegedly in excess of the allowable amount. The health
				care or alternative care provider shall reply in writing within ten calendar
				days of receipt of the request. Failure to comply with the request of the
				insurer shall be reason for the insurer to deny payment.
(d) Fees listed in the Medicare Fee Schedule
				shall be subject to the current Medicare Fee Schedule correct coding initiative
				("CCI") and follow-up rules. The Health Care Financial Administration Common
				Procedure Coding System alphabet codes adopted by Medicare shall not be allowed
				unless specifically adopted by the director of labor.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 24 - MONEY TRANSMITTERS › Subchapter 1 - GENERAL PROVISIONS › Section 16-24-2 - Definitions

Current through June, 2024
As used in this chapter:
"Commissioner" means the commissioner of financial
				  institutions.
"Division" means the division of financial institutions
				  within the department of consumer and consumer affairs.
"Insolvency" means that a money transmitter is unable to pay
				  its debts in the usual course of trade and business.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 24 - MONEY TRANSMITTERS › Subchapter 1 - GENERAL PROVISIONS › Section 16-24-3 - Public review of money transmission applications and records; exceptions

Current through June, 2024
(a) Subject to other provisions of this
				chapter, all applications and supporting documents that are filed by a proposed
				money transmitter shall be available for public review as provided by law
				following receipt of a request to review the records.
(b) Subject to other provisions of this
				chapter, all applications, supporting documents, and records filed by a money
				transmitter, including audited statements and records relating to bonding and
				insurance, shall be available for public review as provided by law following
				receipt of a request to review the records.
(c) Information claimed by an applicant or
				money transmitter to be confidential shall be submitted on separate pages which
				can be detached from the rest of the application or filing and shall be
				identified by the words "Submitted as Confidential" printed on the top of each
				page. Information submitted as confidential shall be accompanied by a separate
				statement requesting confidential treatment and providing reasons and authority
				for maintaining confidentiality.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 24 - MONEY TRANSMITTERS › Subchapter 1 - GENERAL PROVISIONS › Section 16-24-4 - Confidential portion of application or records

Current through June, 2024
No material contained in any application or record shall be
				  made available to the public if it is determined by the commissioner to be
				  confidential. Information that may be considered confidential includes, but is
				  not limited to, the following:
(1)
				Commercial or financial information, the disclosure of which would, or would be
				likely to, result in substantial competitive harm to the applicant or money
				transmitter;
(2) Information, the
				disclosure of which could seriously affect the financial condition of the
				applicant or money transmitter;
(3)
				Personal information, the release of which would, or would be likely to,
				constitute an unwarranted invasion of privacy; or
(4) Other information, the disclosure of
				which is prohibited by section
				489D-19,
				HRS.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 24 - MONEY TRANSMITTERS › Subchapter 2 - APPLICATION FORMS AND FEES › Section 16-24-8 - General procedures

Current through June, 2024
Any person desiring to obtain the approval of the
				  commissioner for any application required by chapter
				  489D, HRS, shall:
(1) File an application in the form
				prescribed by this chapter; and
(2)
				File the appropriate application fee.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 24 - MONEY TRANSMITTERS › Subchapter 2 - APPLICATION FORMS AND FEES › Section 16-24-9 - Application forms; fees

Current through June, 2024
(a) Each
				application required by chapter
				489D, HRS, shall be made by
				completing and submitting to the commissioner, in duplicate:
(1) The application form prescribed by the
				commissioner, copies of which may be obtained by request from the division;
				or
(2) The application in letter
				form, if no application form has been prescribed by the commissioner. The
				application in letter form shall state in detail the nature and scope of the
				requested consent or approval and all information reasonably required for the
				commissioner's review and consideration of the application.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 24 - MONEY TRANSMITTERS › Subchapter 3 - STANDARDS OF REVIEW; DECISIONS › Section 16-24-14 - Rights of applicants; obligations of commissioner

Current through June, 2024
An applicant has a right to file an application and to
				  obtain full consideration of the application by the commissioner in light of
				  all relevant facts and without prejudice. If all of the relevant criteria are
				  resolved favorably, the applicant is entitled to receive the requested
				  authorization. In the event an application is disapproved, an applicant has a
				  right to be informed by the commissioner of the reasons for
				  disapproval.
Hawaii Administrative Rules › Title 16 - DEPARTMENT OF COMMERCE AND CONSUMER AFFAIRS › Chapter 24 - MONEY TRANSMITTERS › Subchapter 3 - STANDARDS OF REVIEW; DECISIONS › Section 16-24-15 - Criteria for proposed money transmitters

Current through June, 2024
Criteria applied by the commissioner in investigating an
				  applicant for a money transmitter's license may include, but are not limited
				  to:
(1) General character of
				management. This may include an evaluation of management's current and past
				business experience; financial resources and interests; and the allocation of
				proposed duties and responsibilities in relation to prior business experience
				and capabilities.
(2) Financial
				history and condition. This may include a review, if requested, of pro forma
				statements, a schedule and appraisal of assets, and an evaluation of the
				applicant's net worth relative to its volume of business.