Hawaii Health Insurance Guide
Hawaii Health Insurance Information, Health Organizations and Resources and access to online health insurance quotes
When you live in Hawaii, you have your choice of health insurance plans offered for individuals and groups provided by private insurance carriers, as well as Hawaii State-funded programs for eligible individuals and families, and federal programs such as Medicaid and COBRA.
Hawaii is not a guarantee issue state. That means private insurance companies are not required to sell health insurance to individuals who do not meet their underwriting criteria. You can be turned down for any number of reasons including your past or current health. If you are accepted, the insurer has the right to impose a 36-month exclusionary period for any pre-existing conditions. There is no limit on the look-back period, meaning your Hawaii health insurance provider can review your health history indefinitely. Any claim you make can be subject to a look-back and if your insurer decides that the condition was pre-existing, your claim can be denied. Premiums on individual plans can be based on age, health status, gender, lifestyle habits, health history and the type of plan you have.
Hawaii is a guaranteed renewal state. Regardless of your health, your insurer must renew your individual health insurance policy as long as you’ve paid your premiums on time and haven’t defrauded the company, or in the case of some HMOs, as long as you haven’t moved out of the service area. Your policy can be canceled, however, if your Hawaii health insurer decides to discontinue your plan.
Hawaii law requires that all employers offer health insurance benefits to any employee who works 20 hours or more per week and to pay at least half of the employee’s health insurance premiums. All group health policies must be guarantee issue, but unlike most other states, group policies in Hawaii are medically underwritten. Rates are at the underwriter’s discretion, although they must be deemed reasonable for the coverage provided and have prior approval by the state’s department of insurance.
Hawaii Mandated Health Benefits
Hawaii laws require private health insurance policies to cover several state-mandated benefits. These currently include:
- Alcoholism and Drug Abuse Treatment
- Ambulatory Surgery
- Diabetic Self Management and Supplies
- Emergency Services
- Hospice Care
- In Vitro Fertilization
- Mastectomy and Mastectomy Stay
- Maternity and Maternity Stay
- General and Parity Mental Health
- Well-Child Care
- Coverage for newborns and adopted children under their parent’s policy
- Coverage for continuation and handicapped dependents under their parent’s policy.
Types of Health Insurance Plans Available in Hawaii
The following major medical health insurance plans are generally available in Hawaii. Major medical plans cover illness and injury, hospitalization, prescription drugs and office visits, as well as the mandated services stated above.
Indemnity plans - Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health providers and facilities. Depending on your plan, you will have to pay a deductible or co-insurance.
Preferred provider organization plans (PPOs) - You select from a network of preferred health care providers and facilities, and receive services at an agreed-upon discounted rate. You also have the option of going outside the network, but typically at a higher cost. You do not need a referral from a primary care physician to see a specialist. Premiums may be less than an indemnity plan but more than an HMO. You will have to pay a deductible or co-insurance.
Health maintenance organizations (HMOs) - HMOs plans require you to select a primary care physician from a prescribed network of providers, who must issue a referral before you can see a specialist. Services and covered costs are typically more comprehensive than those provided by a PPO. HMOs offer the advantage of affordable premiums and low out-of-pocket costs, with an emphasis on preventive care. Non-emergency services out of network are usually not reimbursed.
Point of Service plans (POS) - Similar to a PPO in that you will receive reimbursement for out-of-network care, but with an HMO’s requirement for a primary care physician who must provide referrals to specialists. Premiums, co-pays and co-insurance are typically higher than what you’d pay with an HMO.
Alternative Health Programs in Hawaii
Hawaii does not have a high risk pool for medically uninsurable residents, but does require any private health insurers who sell policies in the state to guarantee issue of health insurance for HIPPA-eligible residents.
Hawaii QUEST provides comprehensive health care to eligible resident children through the age of 19 who meet certain income requirements. Eligibility requirements include income limits. To qualify, the child cannot be insured through another source during the month of application, in a public institution or certified blind or disabled. Waiting periods apply. Covered benefits include office visits, emergency room care, surgery, prescription drugs, lab work and x-rays, vision and dental care, inpatient mental health services, maternity services and contraceptives. There are no costs for QUEST health plans or services. Enrollment is for 12 months, provided the child stay in the household and doesn’t get any other health coverage. Annual renewal is required.
The Hawaii State Department of Insurance is responsible for regulating Hawaii’s health insurance industry.
Get access to Hawaii health insurance quotes from http://www.EINSURANCE.com/health-insurance/.
Department of Commerce & Consumer Affairs
PO Box 3614
Honolulu, Hawaii 96811
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
110 William Street
New York, NY 10038