Hawaii Administrative Code

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 ma…

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. Notes Haw. Code R. § 12-12-32 [Eff: 5/7/81] (Auth: …

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 p…

Notes Haw. Code R. §§ 12-12-34 to 12-12-40

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. Notes Haw. Code R. § 12-12-4 [Eff: 5/7/81] (Auth: HRS § 393-32) (Imp: HRS § 393-11)

(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 emplo…

(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. (b) If an employee is no longer employed by the employer and…

(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. Notes Haw. Code R. …

(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 empl…

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…

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…

Notes Haw. Code R. §§ 12-12-47 to 12-12-59

An employee exempt under the statute shall immediately file with the employer on a form provided by the department the reason for such exemption. Notes Haw. Code R. § 12-12-5 [Eff: 5/7/81] (Auth: HRS § 393-32) (Imp: HRS §§ 393-15, 393-16, 393-17, 393-18, 393-21)

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. Notes Haw. Code R. § 12-12-6 [Eff: 5/7/8…

(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 unempl…

(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 …

(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 employe…

(a) Status report. 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 the status report form is mailed by the department. This report shall provide informa…

Each employer shall post and maintain in a conspicuous place or places in and about the place of business type-written or printed notices stating that the employer has obtained health care coverage required by law, in the form as may be prescribed by the director. Notes Haw. Code…

Notes Haw. Code R. §§ 12-12-65 to 12-12-69

The council shall have discretion in determining which plans qualify under section 393-7, HRS. Notes Haw. Code R. § 12-12-7 [Eff: 5/7/81] (Auth: HRS § 393-32) (Imp: HRS § 393-7)

(a) "Less than eight employees" shall mean the total number of employees who are entitled to and covered as of the twelfth day of each calendar month. An employer who provides coverage to eight or more employees entitled to coverage in a month shall not qualify for premium supple…

(a) A claim for premium supplementation for an employer's taxable year shall be filed with the department within two years after the end of such year. Any claim filed after two years shall not be honored. (b) The premium supplementation claim shall be filed on a form designated b…

(a) The amount of premium supplementation due shall be reduced by the experience rating credit or dividend received by the employer from a health care contractor. (b) If an experience rating credit or dividend is received after the premium supplementation is paid to the employer,…

(a) Notwithstanding section 12-12-41(d), the premium supplementation fund shall provide benefits to an eligible employee whose employer has failed to provide coverage in the following manner: (1) The eligible employee shall be deemed to have selected the most prevalent reimbursem…

Notes Haw. Code R. §§ 12-12-74 to 12-12-75

Penalties under section 393-33, HRS, shall be assessed by the director, or a designated representative, after hearings held in accordance with chapter 91, HRS. Notes Haw. Code R. § 12-12-76 [Eff: 5/7/81] (Auth: HRS § 393-32) (Imp: HRS § 393-33)

The director's rights and duties shall be that prescribed by chapters 371 and 393, HRS. Notes Haw. Code R. § 12-12-8 [Eff: 5/7/81] (Auth: HRS § 393-32) (Imp: HRS §§ 393-31, 393-32)

Notes Haw. Code R. §§ 12-12-9 to 12-12-10

All specialists who do not meet the requirements of section 12-14-16(a) but do meet the requirements of sections 12-14-16(c) and 12-14-22 may be re-registered for a period of three years provided they have maintained their registration with the director. Written application for r…

(a) The employer may file an objection to a proposed plan, revision, or modification with the director, copying the employee and the vocational rehabilitation counselor within ten calendar days from the postmark date of the plan, revision, or modification. The front page of the o…

A plan or program prepared by an employee of a self-insured employer or insurance carrier may be accepted by the director provided the employee approves the plan or program and it meets all the requirements of this chapter. Notes Haw. Code R. § 12-14-11 [Eff. 1/1/81; am 1/28/85; …

A plan or program at a site other than the island on which the employee resides will be approved by the director only when it is shown that no rehabilitation program could be made available on that island. A plan or program at a site located outside the state will be approved by …

Notes Haw. Code R. §§ 12-14-13 to 12-14-15

(a) An applicant seeking registration with the department as a registered rehabilitation specialist shall apply to the director. The applicant may be registered if the director finds the applicant has a current certification by the Commission on Rehabilitation Counselor Certifica…

The registration granted a registered rehabilitation specialist or the certification granted a certified rehabilitation provider shall be in effect for one year from date of registration or certification. After the initial registration or certification, the specialist or provider…

A provider or employee of the provider who provides services to employees without obtaining certification or registration from the director shall be required to terminate those services immediately, and shall not be considered for certification or registration for a period of two…

The director may revoke the certification of a provider or the registration of a specialist, or both, for a period up to two years if following an investigation, to include an opportunity for the specialist or provider, or both, to respond, the director finds that the provider or…

Notes Haw. Code R. § 12-14-16.2

The director may revoke a provider's certification or specialist's registration for a period of up to two years pursuant to section 12-14-19 or take action as defined in section 12-14-21 for infractions such as: (1) Knowingly providing false or misleading information during the e…

The director shall enforce sections 12-14-20 and 12-14-22. Failure to comply with these sections may result in one or a combination of the following: (1) A written warning from the director; (2) Requirement of hours of training in the area of deficiency, with no new cases to be a…

(a) Specialists shall meet the requirements of this section. (b) Specialists shall obtain a minimum of sixty hours of formal training directly related to vocational rehabilitation every three years at an accredited institution or 20 hours for each year registration is granted in …

(a) The employee in accordance with section 386-25, HRS, and within the limits established by section 12-14-36, initially may select and initiate services with any one certified rehabilitation provider as established in section 12-14-16. All subsequent changes or transfers of pro…

Notes Haw. Code R. §§ 12-14-24 to 12-14-25

The primary purpose of a plan is to restore an employee to suitable gainful employment as quickly as possible in a cost-effective manner. The plan is written by the employee and the specialist, and is not considered a plan without the approval of the employee. The director upon r…

The provider shall submit reports on the status and progress of the employee's plan to the employer and employee every thirty days. Upon request, the provider shall submit the reports to the director. The status reports shall include but not be limited to the following: (1) Objec…

Notes Haw. Code R. § 12-14-28