reglab/statecodes huggingface dataset:
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 3 - BENEFITS AND CLAIMS PROCEDURES › Section 12-11-45 - Authorized physician, surgeon, dentist, chiropractor, osteopath, naturopath, or equivalent

Current through June,
				2024
Pursuant to section
				  392-26(a)
				  and (b), HRS, an authorized physician,
				  surgeon, dentist, chiropractor, osteopath, or naturopath includes any person
				  duly licensed to practice medicine, surgery, dentistry, chiropractic,
				  osteopathy, or naturopathy in this State; or a duly authorized or accredited
				  practitioner or any group which depends for healing upon prayer or other
				  spiritual means. If a claimant is a bona fide resident of another state,
				  nation, or other recognized unit of government, or if a claimant is disabled
				  while temporarily in another state, nation, or other recognized unit of
				  government, the medical statement and necessary reports of the attending
				  physician duly licensed under its laws to practice medicine, surgery,
				  dentistry, chiropractic, osteopathy, or naturopathy may be accepted as proof of
				  disability.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 3 - BENEFITS AND CLAIMS PROCEDURES › Section 12-11-46 - Average weekly wage

Current through June,
				2024
(a) Except as
				otherwise provided herein or when shown to be inappropriate or unfeasible, for
				the purpose of computing the amount of disability benefits of a non-salaried
				employee during any period of disability, "average weekly wage" shall be the
				amount determined by dividing the total wages earned by the employee in the
				employment of the employee's last employer for the eight weeks or portion
				thereof that the employee was in the employment immediately preceding and
				including the employee's last day worked prior to commencement of the
				disability, by the number of weeks or portion thereof of the
				employment.
(b) If an employee's
				remuneration consists of commissions or piece-work pay, the commissions or
				piece- work pay earned by the employee during the fifty-two consecutive weeks
				immediately preceding the date of the employee's disability shall be used in
				determining the employee's average weekly wage.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 3 - BENEFITS AND CLAIMS PROCEDURES › Section 12-11-47 - Cash value of remuneration in kind

Current through June,
				2024
(a) Board, lodging,
				or any other payment in kind received by an employee from the individual's
				employer in addition to or in lieu of (rather than as a deduction from) money
				wages shall be deemed to be wages paid by the individual's employer.
(b) The reasonable cash value of such
				payments in kind, as established by the department, shall be used in
				determining the wages paid to the employee and in computing contributions due
				from the employer and the employee.
(c) Where a money value for such payments in
				kind is agreed upon in a contract of hire, the amount so agreed upon shall, if
				more than the rates specifically determined by the department or the rates
				prescribed herein, be deemed the cash value of such payment.
(d) Effective January 1,1978 and until
				amendments to rule 2 of Regulation I relating to the administration and
				enforcement of the Hawaii employment security law are promulgated, board and
				lodging furnished as payment in kind shall be deemed to have not less than the
				following values:
Full board and room, weekly .........
$28.00
Meals, per week ..................
18.90
per day ...................
2.70
per meal ..................
.90
Lodging, per week ..................
9.10
per day ...................
1.30
(e)
				When amendments to rule 2 of Regulation I relating to the administration and
				enforcement of the Hawaii employment security law are promulgated, subsection
				(d) shall be deemed to have been amended to reflect such change.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 3 - BENEFITS AND CLAIMS PROCEDURES › Section 12-11-48 - Change in average weekly wage

Current through June,
				2024
In the event a claimant is disabled at the end of a calendar
				  year and the claimant's disability continues into the next calendar year, the
				  claimant's disability payment shall be calculated on the basis of the
				  established rate at the time the claimant's disability
				  commenced.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 3 - BENEFITS AND CLAIMS PROCEDURES › Section 12-11-49 - Failure to provide coverage

Current through June,
				2024
Should an employer fail to provide coverage after deducting
				  and withholding contributions from the individual employees, the employer shall
				  deposit such contributions not to exceed 0.5 per cent of the employees' weekly
				  wages, as determined pursuant to section
				  392-43,
				  HRS, into the special fund when ordered by the director. Contributions in
				  excess of 0.5 per cent of the employees' weekly wages shall be refunded to the
				  employees. The employer's compliance with this section shall not hold the
				  employer immune to the requirements of the statute.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 3 - BENEFITS AND CLAIMS PROCEDURES › Section 12-11-50 - Deductions greater than authorized

Current through June,
				2024
Pursuant to section
				  392-43(f),
				  HRS, contributions of those employees, deducted and withheld in amounts greater
				  than those authorized, who are no longer with the employer and cannot be
				  located, shall be deposited at the end of each calendar year in the special
				  fund for disability benefits by the employer. The employer shall provide the
				  director with a list containing the employee's full name, social security
				  account number, last known address, the amount due, and any other information
				  requested by the director. The director shall endeavor to locate such employees
				  to return such deductions. If such employees cannot be located for a period of
				  two years from the date of deposit, the director shall cause such monies to
				  become a part of the special fund.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 4 - REQUIREMENTS FOR INSURED COVERAGE › Section 12-11-56 - Posting of notice of coverage

Current through June,
				2024
Each employer shall post and maintain in a conspicuous place
				  or places in and about the employer's places of business typewritten or printed
				  notices stating that the employer has obtained insurance to provide for the
				  payment of disability benefits required by law, in the form as may be
				  prescribed by the director.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 4 - REQUIREMENTS FOR INSURED COVERAGE › Section 12-11-57 - The insurance contract

Current through June,
				2024
(a) Every contract
				of insurance, including any amendment, endorsement, or rider to a contract of
				insurance, which provides for employee benefits under the statute shall be
				approved by the insurance commissioner.
(b) Nothing in the statute or in this chapter
				is intended to amend, modify, or change any policy form approval requirements
				prescribed in the State insurance law.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 4 - REQUIREMENTS FOR INSURED COVERAGE › Section 12-11-58 - Cancellation of an insurance contract

Current through June,
				2024
(a) No insurer
				shall cancel a contract of insurance providing in whole or in part for
				disability benefits required by the statute prior to the expiration date of the
				contract unless notice of intention to cancel on a specified date has been
				filed with and served on the employer and the director at least ten days prior
				to the specified cancellation date.
(b) The ten-day advance notice requirement in
				subsection (a) need not be complied with when a new insurer is substituted. In
				the event of the substitution, the previous insurer shall immediately file with
				and serve on the employer and the director notice that the contract was
				cancelled as of a specified date because the obligation to pay benefits for
				disabilities incurred after the date was assumed by a new insurer which shall
				be specifically identified if its identity is known by the previous
				insurer.
(c) The insurer need not
				file an additional notice of the termination date prescribed in a contract of
				insurance, unless the date was not shown in the notice of insurance filed with
				the director pursuant to section
				392-42,
				HRS.
(d) If a plan provides by its
				terms for an expiration date, acceptance of the plan by the director is notice
				thereof. Additional notice by the insurer of cancellation of the insurance
				contract as of the expiration date of the plan is not necessary.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 4 - REQUIREMENTS FOR INSURED COVERAGE › Section 12-11-59 - Employee contributions toward the cost of coverage under insurance contracts

Current through June,
				2024
(a) If an employer
				provides for disability benefits under the statute by a contract of insurance,
				the premium charged therefor shall represent the cost of providing the
				benefits. The employees' contributions shall not exceed one-half of the cost
				but not more than 0.5 per cent of the employees' weekly wage as determined
				pursuant to section
				392-43,
				HRS.
(b) If, after the end of a
				policy year, the employer receives an experience rating credit or a dividend
				back from the insurer, the employees' share of the experience rating credit or
				dividend shall be refunded or credited to the employees by the employer.
				"Employees' share" means one-half of the excess remaining, if any, after the
				employer has deducted (1) any expenses of the employer directly allocable to
				the cost of administering the insurance contract, and (2) the amount, if any,
				by which the employer's contribution to the premium charged during the prior
				policy years exceeded the employees' contributions. At the employer's option,
				the employer may refund in cash each employee's proportionate share of the
				employees' share, or may credit the total employees' share of the experience
				rating credit or dividend from the prior policy year against the total amount
				contributable by the employees during the current policy year.
(c) The applicable provisions of a
				collectively bargained agreement shall prevail in the event of a conflict
				between those provisions and this chapter.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 4 - REQUIREMENTS FOR INSURED COVERAGE › Section 12-11-60 - Refusal to insure

Current through June,
				2024
If an insurance company refuses to cover any
				  employer-applicant, the insurance company shall notify the employer-applicant
				  in writing of the name and address of the pool manager of the Hawaii temporary
				  disability insurance risk spreading plan. A copy of the letter shall be kept in
				  a separate file at the insurance company for the department's
				  reference.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 5 - REQUIREMENTS FOR SELF-INSURED COVERAGE › Section 12-11-66 - Posting of notice of coverage

Current through June,
				2024
Each employer who has been granted self-insured status
				  pursuant to the statute and this chapter shall post and maintain in a
				  conspicuous place or places in and about the employer's places of business
				  typewritten or printed notices stating that the employer is providing directly
				  for the payment of disability benefits required by law, in the form prescribed
				  by the director.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 5 - REQUIREMENTS FOR SELF-INSURED COVERAGE › Section 12-11-67 - Application

Current through June, 2024
(a) Every employer and every association of
				employers, or trustee or trustees paying benefits under a plan or agreement
				authorized under section
				392-41,
				HRS, desiring to provide for the payment of benefits through approved
				self-insurance, shall apply to the director to become a self-insurer. The
				application shall be in the form prescribed by the director.
(b) If the applicant is an association of
				employers or of employees, or a trustee or trustees, each employer of employees
				for whom benefits under a plan pursuant to section
				392-41,
				HRS, are to be provided by the applicant shall apply, on a form prescribed by
				the director, for acceptance of the plan of the association of employers or
				employees, trustee or trustees, as the plan of the employer.
(c) If the director is satisfied as to the
				financial and administrative ability of the applicant to make payment of the
				benefits provided and that the applicant's tangible assets make reasonably
				certain the payment of all obligations that may arise under the law, the
				application may be granted on the conditions herein provided and such other
				conditions as, in the discretion of the director, may be necessary or desirable
				in any case.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 5 - REQUIREMENTS FOR SELF-INSURED COVERAGE › Section 12-11-68 - Agreement

Current through June, 2024
Each applicant for self-insurance shall execute and file with
				  the director an agreement, on a form prescribed by the director,:
(1) To pay benefits to employees eligible
				under the law:
(A) As provided in the
				statute, if there is no plan applicable to the employees;
(B) As provided by a plan qualifying under
				section
				392-41,
				HRS, for employees covered by the plan.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 5 - REQUIREMENTS FOR SELF-INSURED COVERAGE › Section 12-11-69 - Requirements for self-insurance

Current through June,
				2024
An applicant for self-insurance shall:
(1) Deposit with the State director of
				finance, and keep on deposit, securities which are obligations of the United
				States, or any other state, Hawaii or any of its counties, provided that the
				securities were issued pursuant to law and the faith and credit of the issuing
				governmental agency is pledged for their payment, in an amount acceptable to
				the director, but in no event less than $2,000. Securities deposited shall be
				registered in the name of "Director of Labor and Industrial Relations, State of
				Hawaii". Interest paid on securities deposited with the director of finance
				will be remitted to the applicant for whose account they are deposited, as long
				as the applicant complies with the law and with this chapter; or,
(2) In lieu of securities and at the
				discretion of the director, file with the director of finance the bond of a
				surety company authorized to do business in this State, in a manner and penal
				sum acceptable to the director. Each surety bond shall be undertaken and may be
				enforced in the name of "Director of Labor and Industrial Relations, State of
				Hawaii", or
(3) Upon furnishing
				satisfactory proof to the director of the employer's solvency and financial
				ability to pay the temporary disability benefits herein provided, no insurance
				or security or surety bond shall be required, and the employer shall make
				payments directly to the individual employees, as they become entitled to
				receive the same under the terms and conditions of the statute.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 5 - REQUIREMENTS FOR SELF-INSURED COVERAGE › Section 12-11-70 - Amount of securities or bond

Current through June,
				2024
The amount of securities or of the penal sum of the surety
				  bond which a self-insurer is required to deposit pursuant to section
				  12-11-69 shall be determined by
				  the director. The number of employees involved, the exposure, the financial
				  standing of the applicant, and other factors which the director may deem proper
				  shall be given effect in fixing the amount. In the director's discretion, a
				  deposit in excess of the minimum under section
				  12-11-69 may be required.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 5 - REQUIREMENTS FOR SELF-INSURED COVERAGE › Section 12-11-71 - Proof of ability to process claims

Current through June,
				2024
Each applicant shall submit proof satisfactory to the
				  director that adequate provision has been made by the applicant, and by each
				  employer, to comply with the obligation to pay benefits, and from time to time,
				  upon request, shall satisfy the director that the provision is kept
				  effective.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 5 - REQUIREMENTS FOR SELF-INSURED COVERAGE › Section 12-11-72 - Termination of self-insurer's status and withdrawal of security deposit

Current through June, 2024
(a) A self-insurer who has terminated
				self-insured status, or as to whom approval for self-insurance has been
				revoked, may apply to the director for return of the security deposit or
				cancellation of the surety bond.
(b) After the lapse of twenty-four months
				from termination of self-insurer status and proof satisfactory to the director
				that all claims have been finally adjudicated and paid, that all fines,
				penalties, expenses, and assessments have been paid, and satisfactory
				disposition made of the balance of employee contributions, and otherwise
				complying with the applicable provisions of law, this chapter, and provisions
				of the self-insurer's agreement, the director may release the securities
				deposited or permit cancellation of the surety bond.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 5 - REQUIREMENTS FOR SELF-INSURED COVERAGE › Section 12-11-73 - Self-insurance deposit credit

Current through June,
				2024
If an employer has deposited securities under the workers'
				  compensation law, the director in his discretion may reduce the amount of
				  deposit required under the statute provided the employer has, by agreement
				  satisfactory to the director, made available all deposited securities for all
				  obligations of the employer under both laws.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 5 - REQUIREMENTS FOR SELF-INSURED COVERAGE › Section 12-11-74 - Obligations

Current through June, 2024
The obligations of a self-insurer shall include all
				  obligations and those of each and every employer with respect to those
				  employees for whom the self-insurer provides benefits under the
				  statute.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 5 - REQUIREMENTS FOR SELF-INSURED COVERAGE › Section 12-11-75 - Revocation of self-insurance status

Current through June,
				2024
The director may revoke the approval to self-insure at any
				  time for good cause. Failure to comply with this chapter, or with any award,
				  order, or directive of the director, either by the self-insurer or an employer
				  or employers for whose employees benefits are provided by the self-insurer, is
				  cause for revocation.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 5 - REQUIREMENTS FOR SELF-INSURED COVERAGE › Section 12-11-76 - Employee contributions towards the cost of coverage by a self-insurer

Current through June, 2024
(a) If an employer provides for disability
				benefits under the statute through self-insurance, the cost of the benefits
				shall include any expenses of the employer directly allocable to the cost of
				administering and providing the benefits. The employees' contributions shall
				not exceed one-half the cost but not more than 0.5 per cent of the employees'
				weekly wage as determined pursuant to section
				392-43,
				HRS.
(b) If, at the end of a
				calendar year, the self-insurer determines that an amount in excess of one-half
				the cost has been contributed by employees, the excess shall be refunded or
				credited to the employees by the self-insurer. At its option, the self-insurer
				may refund in cash to each employee the proportionate share of the excess or
				may credit the excess from the prior year to the total amount contributable by
				employees during the current year.
(c) The applicable provisions of a
				collectively bargained agreement shall prevail in the event of a conflict
				between those provisions and this section.
(d) Employees' contributions shall be kept in
				a separate fund maintained by the employer.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 5 - REQUIREMENTS FOR SELF-INSURED COVERAGE › Section 12-11-77 - Limitation of fund

Current through June, 2024
The separate fund provided by section
				  12-11-76 shall not exceed five per
				  cent of the employer's highest monthly payroll in the last twelve completed
				  calendar months. No further deductions shall be made from employees until the
				  fund falls below the five 1/2 percent indicated above. The additional
				  withholdings plus the fund balance shall not exceed five percent of the
				  employer's highest payroll in the last twelve completed calendar months. The
				  director may, based on the actuarial experience of an employer or group of
				  employers, reduce the limitation prescribed by this section.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 6 - REPORTS › Section 12-11-85 - Periodic reports

Current through June,
				2024
(a) On March 1 of
				each year, the employer's insurance carrier, self-insured employers, employers
				with collective bargaining agreements, or an association of employers shall
				file an annual report covering the most recently completed calendar year in a
				form prescribed by the director for each employer and for each plan, furnishing
				the following information:
(1) Number of
				covered employees for each month of the year (number of individuals employed
				during the pay period including the 12th day of the month).
(2) Amount of total wages paid in the
				year.
(3) Amount of taxable wages
				paid in the year.
(4) Amount of
				employer contributions paid in the year, if applicable.
(5) Amount of employee contributions paid in
				the year, if applicable.
(6) Amount
				of benefits paid in the year.
(7)
				Number of different persons paid disability benefits during the year.
(8) Number of weeks for which benefits were
				paid.
(9) Number of separate
				periods of disability for which benefits were paid.
(10) Number of claims denied.
(11) Amount of subrogated payments
				received.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 11 - TEMPORARY DISABILITY INSURANCE › Subchapter 6 - REPORTS › Section 12-11-86 - Other employer reports

Current through June,
				2024
Every employer for whom services are performed in employment
				  shall file a report on a form prescribed by the director to determine liability
				  for coverage within ten days after being mailed by the department. This report
				  shall provide information such as: Under an insured plan, the insurance carrier
				  name, number of employees covered, effective date of coverage, and the amount,
				  if there is any employee contributions toward premium payments; under a
				  self-insured plan, furnishing copies of the plan and financial statement,
				  effective date of plan, number and classes of employees covered, and the
				  amount, if there is any employee contributions toward premium payments; under a
				  sick leave plan covered under an employer-employee collective bargaining
				  agreement, the name of union, copy of agreement, effective and expiration date
				  of agreement, and number and classes of employees covered.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 1 - GENERAL › Section 12-12-2 - Determination of seasonal pursuit and seasonal period

Current
				through June, 2024
(a)
				Employers believing themselves to be engaged in seasonal pursuits shall file a
				request for such determination with the director. The request shall contain
				data and information necessary to qualify the employer within the provisions as
				set forth in section 12-12-1 of this chapter and also as set forth in section
				393-3(8),
				HRS, for the twelve months immediately preceding the date of the request for
				seasonal pursuit determination. The request shall also include similar data and
				information anticipated to be experienced in the current twelve month period.
				The request shall be signed by an authorized representative of the
				employer.
(b) The department shall
				review the request and information submitted and make determinations of
				seasonal pursuit and seasonal period or seasonal periods conforming to section
				12-12-1. The decision of the department shall be certified in writing to the
				requesting employer and will remain in effect for the period specified in the
				decision.
(c) In order to establish
				the seasonal period or periods for each subsequent twelve month period
				following initial determination by the department, the employer shall resubmit
				data and information specified in subsections (a) and (b) not later than one
				calendar month after the expiration date of the department's
				decision.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 1 - GENERAL › Section 12-12-3 - Voluntary Coverage

Current through June,
				2024
An employer may voluntarily cover a person excluded under
				  section
				  393-5, HRS,
				  with a plan which will afford the person health care protection. Such
				  voluntarily covered person shall not be entitled to the protection afforded by
				  the statute or this chapter.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 1 - GENERAL › Section 12-12-4 - Monthly pay of regular employee

Current through June,
				2024
The monthly wages for the purposes of section
				  393-11,
				  HRS, shall be 86.67 times the State's minimum wage rounded off to the next
				  higher dollar.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 1 - GENERAL › Section 12-12-6 - Employee already disabled

Current through June,
				2024
Should an employer elect to change the health care plan or
				  contractor while an employee is disabled, the employer shall provide a
				  reasonable extension of benefits, which may be provided by the previous or
				  succeeding health care contractor.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 2 - PLANS › Section 12-12-12 - More than one plan

Current through June, 2024
An employer may elect to provide more than one approved plan
				  from the same or different health care contractor. The employer shall not be
				  liable for more than the cost of the least expensive plan should there be more
				  than one plan.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 2 - PLANS › Section 12-12-13 - Classes of employees

Current through June,
				2024
An employer may provide different plans for different classes
				  of employees. The employer shall not, however, exceed the withholding
				  requirements of section
				  393-13,
				  HRS, should classes of employees be provided different plans.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 2 - PLANS › Section 12-12-14 - Out-of-state employer-sponsored plans

Current through June,
				2024
Any employer-sponsored plan shall be submitted to the
				  department by the authorized health care contractor in accordance with section
				  12-12-16.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 2 - PLANS › Section 12-12-15 - Collective bargaining agreement

Current through June,
				2024
Any prepaid health care plan included in a collective
				  bargaining agreement:
(1) Is presumed
				to meet the requirements of the statute if the agreement is dated prior to June
				3, 1978.
(2) Shall meet the
				requirement of the statute if the agreement is dated on or after June 3,
				1978.
(3) Shall be filed by the
				employer with the department immediately upon approval of the parties whenever
				effected, modified, renegotiated, or extended.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 2 - PLANS › Section 12-12-16 - Submission of plans by health care contractors

Current through
				June, 2024
(a) After the
				approval of a health plan by the Hawaii State Insurance Commissioner or a
				signed statement that the plan does not require approval, the health care
				contractor shall submit eight copies of the plan to the department for review.
				Each plan shall have attached thereto the evidence of the insurance
				commissioner's approval or the statement that the plan does not require
				approval. Any plan submitted under section
				393-7(b),
				HRS, which provides aggregate benefits that are more limited than those
				provided by plans qualifying under section
				393-7(a),
				HRS, shall include certification that the employer has agreed to contribute at
				least one-half of the cost of the coverage of dependents under such
				plan.
(b) After written advice from
				the prepaid health care advisory council, the director shall notify the health
				care contractor of the proposed approval or disapproval of the plan. Any
				proposal to disapprove shall contain the reasons therefor.
(c) The health care contractor may apply for
				reconsideration in writing within fifteen days after receipt of the proposed
				disapproval. The request for reconsideration shall include a memorandum of the
				facts on the basis of which the contractor contends that the plan meets the
				requirements of section
				393-7,
				HRS.
(d) The director shall notify
				the health care contractor of the final decision to approve or disapprove the
				plan.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 2 - PLANS › Section 12-12-17 - Employer's obligation

Current through June,
				2024
(a) Each employer
				shall inform an eligible employee of the entitlement afforded by this statute
				by providing the health care contractor's name, plan number, group number,
				effective date of coverage, and employee's cost.
(b) The employer shall give each covered
				employee thirty days' notice should the employer elect to change the employer's
				plan or health care contractor.
(c)
				Any employer who withholds premium payments shall provide a covered employee
				who is incapacitated due to illness or injury, the following information in
				writing:
(1) Within two weeks of the
				disability date, the amount the employee is required to pay directly to the
				employer for forwarding to the health care contractor in order to continue
				coverage under section
				393-15,
				HRS.
(2) At least two weeks prior
				to the date an employer will have completed the employer's obligation under
				section
				393-15,
HRS, the entire premium cost the employee is required to pay
				  directly to the employer for forwarding to the health care contractor in order
				  to continue coverage.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 2 - PLANS › Section 12-12-18 - supplemental coverage to required health care benefits

Current
				through June, 2024
(a)
				When a health care contractor whose health care plan has been approved pursuant
				to section
				393-7,
				HRS, subsequently provides supplemental benefits such as vision, drug, and
				dental coverage, these supplemental benefits shall then become a part of the
				employer's health care plan whether or not initiated by employer or employees.
				When current or future employees must subscribe to such health care plan
				without having the option of excluding the supplemental benefits and its
				applicable cost, the cost of the required health care and supplemental benefits
				shall become the basis for allocation of premium specified in section
				393-13,
				HRS.
(b) If an employee can choose
				not to accept the supplemental benefits, the employer may require an employee
				who elects the coverage to pay for the cost of the supplemental
				benefits.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 3 - HEALTH CARE CONTRACTOR REQUIREMENTS › Section 12-12-24 - Self-insurer

Current through June, 2024
Any self-insurer may qualify as a health care contractor upon
				  furnishing satisfactory proof to the director of its solvency and financial
				  ability to defray or reimburse in whole or in part the expenses of health care
				  under an approved health care plan.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 3 - HEALTH CARE CONTRACTOR REQUIREMENTS › Section 12-12-25 - Health care contractor

Current through June,
				2024
Every health care contractor required to be licensed by the
				  Hawaii State Insurance Commissioner shall be so licensed before submission of
				  plans to the department.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 3 - HEALTH CARE CONTRACTOR REQUIREMENTS › Section 12-12-26 - The health care insurance contract

Current through June,
				2024
(a) Every health
				care contract of insurers subject to the insurance laws of the State, including
				any amendment, endorsement, or rider to a contract, which provides for benefits
				under section
				393-7,
				HRS shall be approved by the Hawaii State Insurance Commissioner prior to
				submission to the director under section 12-12-16.
(b) Nothing in the statute or this chapter is
				intended to amend, modify or change any policy form approval requirements
				prescribed in the State insurance laws.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 3 - HEALTH CARE CONTRACTOR REQUIREMENTS › Section 12-12-27 - The health care certificate

Current through June,
				2024
(a) Every covered
				employee shall be given written evidence of health care coverage by the
				employer, which has been provided by the health care contractor.
(b) The health care contractor shall permit
				continuation of coverage without any diminution of benefits or standards from
				the plan with which an employee was covered prior to disability during the
				period specified in section
				393-15,
				HRS.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 3 - HEALTH CARE CONTRACTOR REQUIREMENTS › Section 12-12-28 - Cancellation of contract

Current through June,
				2024
(a) No health care
				contractor shall cancel a contract providing in whole or in part for health
				care benefits required by the statute prior to the expiration date of the
				contract unless written notice of intention to cancel on a specified date and
				reason therefor has been filed with and served on the employer and the director
				at least ten days prior to the specified cancellation date.
(b) The ten days' advance notice requirement
				in subsection (a) need not be complied with when a new contractor is
				simultaneously substituted. In the event of substitution, the previous
				contractor shall immediately file with and serve on the employer and the
				director, notice that the contract was canceled, the specific date and the
				reason for cancellation.
(c) If a
				plan provides by its terms for an expiration date, acceptance of the plan by
				the director is notice thereof.
(d)
				The employer shall notify its covered employees of the cancellation of coverage
				for nonpayment of premium. The employees shall be given an option of individual
				coverage if premium payment is made within ten days directly to the
				contractor.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 3 - HEALTH CARE CONTRACTOR REQUIREMENTS › Section 12-12-29 - Refusal to insure

Current through June,
				2024
No health care contractor other than a self-insurer shall
				  refuse to cover any employer-applicant except for the non-payment of premiums.
				  The health care contractor shall notify the director of all refusals to
				  insure.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 3 - HEALTH CARE CONTRACTOR REQUIREMENTS › Section 12-12-30 - Disqualification for benefits

Current through June,
				2024
Subject to the terms of the health care contract, a covered
				  employee shall not be disqualified for benefits by a health care contractor
				  except for the nonpayment of premium.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 3 - HEALTH CARE CONTRACTOR REQUIREMENTS › Section 12-12-31 - Agent

Current through June, 2024
Each health care contractor shall provide the department with
				  the name of an employee or officer of the contractor who is in direct charge of
				  health care matters to whom all correspondence should be addressed. The person
				  should be one who can be reasonably expected to expedite matters relating to
				  the statute.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 3 - HEALTH CARE CONTRACTOR REQUIREMENTS › Section 12-12-32 - Contractors of union plans

Current through June,
				2024
Except as to section
				  12-12-16, all health care
				  contractors, including self-insurers, providing benefits in accordance with a
				  collective bargaining agreement shall comply with all the requirements of the
				  statute and this chapter.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 3 - HEALTH CARE CONTRACTOR REQUIREMENTS › Section 12-12-33 - Contractors of approved plans

Current through June,
				2024
Prepaid health care contractors with plans approved pursuant
				  to section
				  393-7,
				  HRS, are required to submit to the department of labor and industrial relations
				  every December 31 the number of subscribers enrolled under each of their plans.
				  If the subscriber count of one of their plans exceeds the count of their plan
				  with the largest number of subscribers, the department must be notified within
				  thirty days of such change.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 4 - BENEFITS AND CLAIMS PROCEDURE › Section 12-12-41 - Withholding by employers

Current through June,
				2024
(a) An employer
				electing to withhold from covered employees may withhold the proportionate cost
				of the premium each pay period beginning in the month the employees' coverage
				becomes effective. In no event shall the employer withhold premiums less often
				than once monthly. An employer shall not withhold more than 1.5 percent of such
				employee's regular wages or one-half the cost of premium, whichever is less,
				during each calendar month.
(b)
				Withholdings by an employer shall be promptly paid to the health care
				contractor in accordance with the billing requirements of the
				contractor.
(c) Any employer fails
				to transmit payments to the health care contractor in accordance with the
				billing requirements of the contractor shall be penalized as provided under
				section
				393-33,
				HRS.
(d) In the event an employer
				withholds but fails to obtain coverage from a health care contractor, the
				employer shall:
(1) Be liable for all health
				care expenses incurred by the employee.
(2) Refund the withheld premium to all
				employees.
(3) Be subject to
				penalties prescribed by section
				393-33,
				HRS.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 4 - BENEFITS AND CLAIMS PROCEDURE › Section 12-12-42 - Deductions greater than authorized

Current through June,
				2024
(a) In the event an
				employer withholds more than authorized by section
				393-13,
				HRS, the employer shall:
(1) Refund such
				excess withholdings to the employee.
(2) Be subject to penalties prescribed by
				section
				393-33,
				HRS.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 4 - BENEFITS AND CLAIMS PROCEDURE › Section 12-12-43 - Notice and proof of claim

Current through June,
				2024
(a) Any covered
				employee claiming benefits or someone acting in behalf of the employee shall
				furnish a written claim to the health care contractor pursuant to the health
				care contract.
(b) The claim shall
				include documents required by the health care contract.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 4 - BENEFITS AND CLAIMS PROCEDURE › Section 12-12-44 - Denial of claim

Current through June, 2024
(a) If an employee's claim is denied by a
				health care contractor in whole or in part because of nonpayment of premium,
				notice of denial in a form prescribed by the director shall be mailed promptly
				to the employee.
(b) If an employee
				desires a review of the denied claim, the employee shall file the prescribed
				notice of denial and a statement giving specific reasons for the request with
				the director. The request for review shall be filed within twenty days after
				the date of denial at the office of the department in the county in which the
				claimant resides or to any office of the department. The director shall
				forthwith notify the health care contractor of the claimant's request for
				review, enclosing a copy of the claimant's reasons therefor.
(c) The director, or an officer or employee
				designated by the director for that purpose, shall investigate the request and
				render a decision. The decision is final with right of appeal in accord with
				section
				91-14,
				HRS.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 4 - BENEFITS AND CLAIMS PROCEDURE › Section 12-12-45 - Controverted workers' compensation claims

Current through June,
				2024
In the event of a controverted workers' compensation claim,
				  the health care contractor shall pay or provide for the medical services in
				  accordance with the health care contract and notify the department of such
				  action. If workers' compensation liability is established, the health care
				  contractor shall be reimbursed by the workers' compensation carrier such
				  amounts authorized by chapter
				  386, HRS, and chapter
				  10 of title 12, administrative
				  rules.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 4 - BENEFITS AND CLAIMS PROCEDURE › Section 12-12-46 - Experience rating

Current through June,
				2024
If, after the end of a policy year, the employer receives an
				  experience rating credit or a dividend from the health care contractor, the
				  employee's share of the experience rating credit or dividend shall be refunded
				  by the employer or applied to future premium payments of covered employees.
				  "Employee's share" means the mathematical ratio of employer-employee
				  contributions of the experience rating credit or dividend proportionately
				  divided among all covered employees by months of service for the period of
				  credit.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 5 - REPORTS › Section 12-12-60 - Health care contractors

Current through June,
				2024
(a) Health care
				contractors shall submit a monthly report, in a form designated by the
				department, showing the following information:
(1) Name of newly enrolled or terminated
				employer;
(2) State department of
				labor and industrial relations account number as assigned by the unemployment
				insurance division;
(3) Plan
				number;
(4) Group number;
(5) Effective date of coverage; and
(6) Effective date and reason for
				cancellation.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 5 - REPORTS › Section 12-12-61 - Employers

Current through June, 2024
(a) On April 15 of each year, all employers
				providing coverage through a health care contractor shall file an annual report
				for each plan covering the most recently completed calendar year. This report
				shall be on a form prescribed by the director and shall provide the following
				information:
(1) Amount of total wages paid
				to covered employee;
(2) Amount of
				employer contributions paid in the year, and
(3) Amount of covered employee contributions
				paid in the year, if applicable.
Hawaii Administrative Rules › Title 12 - DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS › Chapter 12 - PREPAID HEALTH CARE › Subchapter 5 - REPORTS › Section 12-12-62 - Principal and secondary employer

Current through June,
				2024
(a) Any principal
				employer who is informed by an employee to be the secondary employer shall
				immediately notify the department of such change on the form provided by the
				department.
(b) Any secondary
				employer who is subsequently informed by an employee to be the principal
				employer shall immediately notify the department of such change on the form
				provided by the department.