Title 24, Insurance

§431L-1 Insurers prohibited from taking medicaid status into account. Any health insurer (including a self-insured plan, a group health plan as defined in section 607(1) of the Employee Retirement Income Security Act of 1974, a health service benefit plan, a mutual benefit societ…

§431L-2 State's right to third party payments. To the extent that payment has been made under the state plan for medical assistance for health care items or services furnished to an individual in any case where another party has a legal liability to make payment for such assistan…

§431L-2.5 Insurer requirements. Any health insurer as identified in section 431L-1 shall: (1) Provide upon the request of the State, information for all of its members to determine during what period the individual or individual's spouse or dependents may be or may have been cove…

§431L-3 Coverage of children. (a) No insurer shall deny enrollment of a child under the health plan of the child's parent for the following grounds: (1) The child was born out of wedlock; (2) The child is not claimed as a dependent on the parent's federal tax return; or (3) The c…

§431L-4 Employer obligations. Where a parent is required by a court or administrative order to provide health coverage, which is available through an employer doing business in this State, the employer is required: (1) To permit the parent to enroll under family coverage, as defi…

[§431L-5] Recoupment of amounts spent on child medical care. The department of the attorney general may garnish the wages, salary, or other employment income of, and withhold amounts from state tax refunds to, any person who: (1) Is required by court or administrative order to pr…

[§431L-6] Requirements for coverage of an adopted child. (a) In any case in which a group health plan provides coverage for dependent children of participants or beneficiaries, the plan shall provide benefits to dependent children placed with participants or beneficiaries for ado…

§431M-1 Definitions. Whenever used in this chapter, unless the context otherwise requires: "Advanced practice registered nurse" means a person licensed pursuant to chapter 457. "Alcohol dependence" means any use of alcohol which produces a pattern of pathological use causing impa…

§431M-2 Policy coverage. (a) All individual and group accident and health or sickness insurance policies issued in this State, individual or group hospital or medical service plan contracts, and nonprofit mutual benefit society, fraternal benefit society, and health maintenance o…

§431M-4 Mental illness, alcohol and drug dependence benefits. (a) Alcohol and drug dependence benefits shall be as follows: (1) Detoxification services as a covered benefit under this chapter shall be provided either in a hospital or in a nonhospital facility that has a written a…

§431M-6 Rules. The insurance commissioner, after consultation with all interested parties including the director of health, the Hawaii medical board, the board of psychology, and representatives of insurance carriers, nonprofit mutual benefit societies, health maintenance organiz…

[§431M-7] Preservation of certain benefits. Nothing in this chapter shall serve to prevent the offering or acceptance of benefits required by this chapter. [L 1988, c 202, pt of §1, §3; am L 1994, c 111, §4; am L 1998, c 78, §3; am L 2002, c 239, §1]

[§431N-1] Findings and purpose. (a) The legislature finds that despite the fact that Hawaii has the only statutorily mandated prepaid health care program in the country, as well as a broad-based medicaid program which provides an array of medical benefits to Hawaii's lowest incom…

[§431N-2] Definitions. As used in this chapter unless otherwise indicated by the context: "Gap group individuals" means medically uninsured persons who are residents of the State. "Health care contractor" means any medical group or organization which undertakes, under a prepaid h…

[§431N-3] State health insurance program established. There is established within the department of health the state health insurance program whose goals shall be to: (1) Subsidize health care coverage for gap group individuals, including but not necessarily limited to outpatient…

§431N-4 Transfer of funds. The department of health shall have the authority to utilize funds appropriated under this chapter to directly purchase services in accordance with chapter 103F when it is determined that such a purchase is more effective and cost efficient in meeting t…

[§431N-5] Rulemaking authority. The director of health shall adopt rules in accordance with chapter 91 which are necessary to carry out this chapter. The rules shall include, but need not be limited to: (1) Establishment of guidelines for the purchase of health care coverage from…

§431N-6 Reporting, continued funding. The department of health shall report to the legislature on or about October 1, 1989, on the progress made in implementation of this chapter, including: (1) Establishment of an advisory committee to review: the scope of the work to be done by…

[§431N-7] Violation, penalty. Any person who violates this chapter or any rule adopted by the department of health pursuant to this chapter may be permanently disqualified from participation in the program, required to reimburse any benefits wrongfully obtained, and shall be fine…

[§431N-8] Severability. If any provision of this chapter, or the application thereof to any person or circumstance is held invalid, the invalidity shall not affect other provisions or applications of this chapter which can be given effect without the invalid provision or applicat…

PART I. GENERAL PROVISIONS §431P-1 Definitions. As used in this chapter, unless the context otherwise requires: "Board" means the board of directors of the Hawaii hurricane relief fund. "Commissioner" means the insurance commissioner as defined in section 431:2-102. "Companion po…

§431P-10 Coverage available from the fund; deductible. Coverage limits and deductibles for policies issued by the fund covering eligible property shall be established in the plan of operation, subject to approval by the commissioner. [L 1993, c 339, pt of §2; am L Sp 1995, c 17, …

§431P-11 Underlying policy required; hurricane coverage shall be provided. (a) Any eligible property for which coverage is sought from the fund shall already be insured by an underlying policy of property insurance as defined in section 431:1-206 or article 21 of chapter 431 but …

[§431P-12] Mitigation. The fund shall develop a comprehensive loss reduction plan for the hurricane peril. The plan shall include standards for new residential and commercial structures and separate standards for existing residential and commercial structures. The plan shall prov…

[§431P-13] Appeals. (a) Any applicant or policyholder adversely affected by a decision of the fund shall have the right to appeal to the fund's board within thirty days after the decision. The application for an appeal shall specify how the person making the appeal was aggrieved …

§431P-14 Immunity and limitation on liability. There shall be no liability on the part of, and no cause of action of any nature shall arise against, any servicing facility or its authorized insurance producers; the fund or its agents, employees, or board; the State; the commissio…

[§431P-15] Exemption from property and liability insurance guaranty association; insolvency of fund. Notwithstanding any other provision of law to the contrary, neither the fund nor its policyholders shall be subject to the provisions of, or be eligible for, the benefits provided…

§431P-16 Establishment of trust funds. (a) The fund shall establish outside the state treasury a hurricane reserve trust fund and any accounts thereunder and any other trust fund or account necessary to carry out the purposes of this chapter. Moneys deposited in the hurricane res…

§431P-16.5 Immunity. There shall be no cause of action, claim for damages or relief, charge, or any other liability of any kind whatsoever created against the State, the Hawaii hurricane relief fund, the commissioner, or their respective agents, employees, or board, by, or relati…

[§431P-18] Exemption for Hawaiian home lands. Nothing in this chapter shall prohibit or limit any person from obtaining insurance for property subject to the Hawaiian Homes Commission Act of 1920, as amended, from any insurer other than the fund if such insurance is deemed suffic…

[§431P-19] Recoupment of assessments paid. (a) Subject to the approval of the commissioner, each licensed property and casualty insurer shall annually recoup assessments paid by the licensed property and casualty insurer under sections 431P-5(b)(8)(A) and (B) and 431P-16(d). The …

§431P-2 Establishment of Hawaii hurricane relief fund. There shall be a Hawaii hurricane relief fund to be placed within the department of commerce and consumer affairs for administrative purposes. The fund shall be a public body and a body corporate and politic. Any applicant fo…

[§431P-20] Temporary recording fee; establishment, reduction, and cessation by board. (a) Subject to the approval of the commissioner, the board may activate, reduce, or terminate the collection of a temporary recording fee as provided in this section. (b) The temporary recording…

§431P-3 Board of directors. (a) The board of directors of the fund shall consist of the insurance commissioner as an ex officio voting member and six members appointed by the governor in accordance with section 26-34. The board shall be the policy making body of the fund. As such…

[§431P-4] Planning and assessment functions of the fund; discretion to provide insurance. (a) The fund shall be responsible for monitoring the availability of property insurance, including insurance for covered events, in this State. If at any time the board determines, in its so…

§431P-5 Powers, duties, and functions. (a) The Hawaii hurricane relief fund shall have the following general powers: (1) To sue and be sued; (2) To make and alter policies for its organization and internal administration; (3) To adopt rules in accordance with chapter 91 to effect…

§431P-5.5 Accumulation of $500,000,000 in funds and commitments. (a) Upon written confirmation from the commissioner that the director has secured $500,000,000, in the aggregate, in the form of: (1) Commitments from either the federal government or an agency of the federal govern…

[§431P-6] Advisory committee. To assist it in implementing this chapter the fund may appoint an advisory committee consisting of: (1) Not less than one individual who is employed or trained as a meteorologist and possesses knowledge of the history, trends, and nature of windstorm…

§431P-7 Plan of operation. (a) The fund shall adopt a plan of operation and a manual of rules and rates necessary or suitable to ensure both the solvency and the reasonable and equitable administration of the fund. The adoption of or amendments to the plan of operation and manual…

[§431P-8] Annual statements. (a) The fund shall submit to the commissioner each year, not later than one hundred twenty days after the end of the fund's fiscal year, a financial report in a form approved by the commissioner. (b) The commissioner may require other reports concerni…

§431P-9 Powers of the commissioner. (a) For the purpose of ascertaining the fund's condition or compliance with this chapter, the commissioner shall examine the accounts, records, documents, and transactions of the fund at least once every three years commencing at the time the f…

[§431R-1] Definitions. As used in this chapter, unless the context indicates otherwise: "Beneficiary of a prescription drug benefit plan" or "beneficiary" means a person who is a member, subscriber, enrollee, or dependent of a member, subscriber, or enrollee of or otherwise cover…

[§431R-2] Retail community pharmacies; retail pharmacy network; contractual agreements. (a) An otherwise qualified retail community pharmacy registered to do business in this State that requests to enter into a contractual retail pharmacy network agreement accepting the standard …

[§431R-3] Prescription drugs; beneficiary choice; mail order opt out. (a) If a retail community pharmacy enters into a contractual retail pharmacy network agreement pursuant to section 431R-2, a prescription drug benefit plan, health benefits plan under chapter 87A, or pharmacy b…

[§431R-4] Report to insurance commissioner. (a) No later than March 31 of each calendar year, each prescription drug benefit plan, health benefits plan under chapter 87A, and pharmacy benefit manager shall file with the insurance commissioner, in such form and detail as the insur…

§431R-5 Violations; penalties. (a) The insurance commissioner may assess a fine of up to $10,000 for each violation by a pharmacy benefit manager or prescription drug benefit plan provider who is in violation of section 431R-2 or 431R-3. In addition, the insurance commissioner ma…