Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 1 - GENERAL › Section 12-12-1 - Definitions

Current through June, 2024
As used herein:
"Continuation of coverage in case of inability to earn wages"
				  means that allocation of health care premium will be based on an employee's
				  continuing salary, if this be the case, or the salary or wages that the
				  employee received in the last fully completed month prior to the disability.
				  Thus, the employer must continue the coverage by paying for the employer's
				  share of the premium and the employee must contribute towards the premium to
				  the same extent as prior to the disability.
"Covered employee" means an eligible employee who is provided
				  health care coverage by an employer.
"Department" shall be as defined in section
				  393-3,
				  HRS.
"Director" shall be as defined in section
				  393-3,
				  HRS.
"Eligible employee" means an employee who has worked for an
				  employer for twenty or more hours a week for four consecutive weeks, and earned
				  86.67 times the Hawaii minimum hourly wage.
"Employer" shall be as defined in section
				  393-3,
				  HRS.
"Employment" shall be as defined in section
				  393-3, HRS,
				  and shall include the period an employee is receiving benefits under chapters
				  386 or
				  392, HRS, for a period of not less
				  than that prescribed in section
				  393-15,
				  HRS. It shall also include services performed by an individual for wages or
				  under any contract of hire irrespective of whether the common-law relationship
				  of master and servant exists unless and until it is shown to the satisfaction
				  of the director that:
(1) The individual has been and will continue to be free from
				  control or direction over the performance of the service, both under the
				  contract of hire and in fact;
(2) The service is either outside the usual course of the
				  business for which the service is performed or that the service is performed
				  outside of all the places of business of the enterprise for which the service
				  is performed; and
(3) The individual is customarily engaged in an independently
				  established trade, occupation, profession or business of the same nature as
				  that involved in the contract of service.
"Four consecutive weeks" means any consecutive period of four
				  weeks which an employee worked for an employer.
"Health care contract" means the entire approved plan of the
				  health care contractor including its terms and conditions and benefit
				  schedule.
"Premium" shall be as defined in section
				  393-3,
				  HRS.
"Prepaid health care contractor" shall be as defined in
				  section
				  393-3,
				  HRS.
"Prepaid health care plan" shall be as defined in section
				  393-3, HRS.
				  Prepaid health care plans which have the largest number of subscribers in the
				  State are on file with the state department of labor and industrial relations,
				  disability compensation division, and are available upon request.
"Regular employee" shall be as defined in section
				  393-3, HRS,
				  but does not include dependents of an employee who are covered by a health care
				  plan as an employee of the same employer.
"Regular wages" include an employee's disability income
				  insurance provided for and paid entirely by the employer in excess of that
				  required by any law.
"Seasonal employment" means employment by an employer defined
				  in the second sentence of section
				  393-3(8),
				  HRS, during its seasonal period or seasonal periods.
"Seasonal period or "seasonal periods" means the period or
				  periods of seasonal activity of less than an aggregate of twenty-six calendar
				  weeks in twelve consecutive calendar months in which the volume of employment
				  by the employer in the pursuit, measured in terms of average weekly man hours
				  per week, is at least fifty percent more than the average weekly man hours of
				  employment by the employer in the twelve consecutive weeks in such twelve
				  consecutive calendar months when the volume of employment by the employer is
				  the lowest in such pursuit; provided that employment by an employer in seasonal
				  pursuit engaged in the cultivating, harvesting, and processing of coffee and
				  macadamia nuts and other crops or products constitutes seasonal employment
				  during the employer's seasonal period or seasonal periods, provided further
				  that employment during the seasonal period or seasonal periods by an employer
				  engaged in the cultivating, harvesting, processing, canning, and warehousing of
				  pineapples constitutes seasonal employment.
"Self-insurer" means an employer as defined in section
				  393-3, HRS,
				  who undertakes to provide the prescribed coverage and benefits directly to the
				  employees without the intervention of a plan provided by a health care
				  contractor or insurer subject to the insurance laws of the State.
"Statute" means chapter
				  393, HRS, entitled "Prepaid Health
				  Care Act."
"Wages" shall be as defined in section
				  393-3,
				  HRS.
"Week" means a period of seven consecutive days based on the
				  established work week of each employer.