Note
Article heading amended by L 2002, c 155, §48.
State innovation waiver task force; health care reform plan; reports to 2015-2017 legislature (dissolved June 30, 2017). L 2014, c 158; L 2015, c 184.
Cross References
Conformance to federal law, see §431:2-201.5.
Federally qualified health centers; rural health clinics; reimbursement, see §346-53.6.
Health maintenance organization act, see chapter 432D.
Medicaid-related mandates, see chapter 431L.
Mental health and alcohol and drug abuse treatment insurance benefits, see chapter 431M.
Patients' bill of rights and responsibilities act, see chapter 432E.
Prescription drug benefits, see chapter 431R.
Prescription drugs; mail order opt out option, see §87A-16.3.
Proposed mandatory health insurance coverage and assessment report, see §§23-51, 52.
State health insurance program, see chapter 431N.
Attorney General Opinions
Section 431:10A-601 applied to all parts of article 10A if the category of policy under consideration included family coverage, as defined in §431:10A-103. Att. Gen. Op. 97-10.
The placement of §431:10A-601 in this article, regulating content of insurance contracts, makes clear that the legislative intent was to mandate benefits that must be made available by insurers that write contracts of insurance providing family coverage. Att. Gen. Op. 97-10.
Law Journals and Reviews
Tax Justice and Same-Sex Domestic Partner Health Benefits: An Analysis of the Tax Equity For Health Plan Beneficiaries Act. 32 UH L. Rev. 73 (2009).
Case Notes
As chapter 432D does not cover the field of managed care regulation and because §§432D-2, 432E-1, and this article can be read together and there is no explicit language or policy reason not to give each statute effect, chapter 432D does not repeal chapter 432E by implication. 126 H. 326, 271 P.3d 621 (2012).
Properly licensed HMOs, like plaintiff, were authorized pursuant to §432D-1 to "provide or arrange", at their option, for the closed panel health care services required under the managed care plan program; accident and health insurers were authorized under §431:10A-205(b) to arrange for medical services for members using a defined network of providers, i.e., particular "hospitals or persons"; thus, this article and chapter 432D authorized both accident and health insurers and HMOs, as risk-bearing entities, to provide the closed panel product required by the managed care plan contracts. 126 H. 326, 271 P.3d 621 (2012).
PART I. INDIVIDUAL ACCIDENT AND HEALTH
OR SICKNESS POLICIES
Note
Part heading amended by L 2002, c 155, §48.
Attorney General Opinions
Section 431:10A-601 applied to all parts of article 10A if the category of policy under consideration included family coverage, as defined in §431:10A-103. Att. Gen. Op. 97-10.
Case Notes
Under this article and §431:10A-105(2)(A)(ii), standard "incontestability clause" of contract precluded insurer from denying insured "total disability benefit" contracted for, notwithstanding that HIV infection that caused the disability arguably "manifested" itself prior to policy's effective date of coverage. 86 H. 262, 948 P.2d 1103.
[§431:10A-140] Formulary; accessibility requirements. (a) Each insurer offering or renewing an individual or group accident and health or sickness insurance policy on or after January 1, 2017, shall provide the following information via a public website and through a toll-free number that is posted on the insurer's website:
(1) Its formulary; provided that notice of any changes due to the addition of a new drug or deletion of any existing drug shall be made available no later than seventy-two hours after the effective date of the change; provided further that notice of other changes, including drug strength or form, shall be made available within fourteen calendar days of the effective date of the change;
(2) Provide a system that allows an insured or potential insured to determine whether prescription drugs are covered under the plan's medical benefits and typically administered by a provider, along with any cost-sharing imposed on such drugs;
(3) Indicate a dollar amount range of cost-sharing typically paid by an insured of each specific drug included on the formulary based on the information the insurer has available, as follows:
(A) $100 and under: $;
(B) Over $100 to $250: $$;
(C) Over $250 to $500: $$$;
(D) Over $500 to $1,000: $$$$; and
(E) Over $1,000: $$$$$; and
(4) Display standardized content for the formulary for each product offered by the plan pursuant to recommendations made by the formulary accessibility working group established pursuant to Act 197, Session Laws of Hawaii 2015.
(b) For the purposes of this section, "formulary" means the complete list of drugs preferred for use and eligible for coverage under a policy, including drugs covered under the policy's pharmacy benefit and medical benefit as defined by the health care service plans.
(c) This section shall not apply to limited benefit health insurance as provided in section 431:10A-102.5; provided further that this section shall not apply to medicare, medicaid, or other federally financed plans. [L 2015, c 197, §1]
Note
Formulary accessibility working group; recommendations for standard formulary template to 2016 legislature (dissolved June 30, 2016). L 2015, c 197, §4.
Section: Previous 431-10a-121 431-10a-122 431-10a-125 431-10a-126 431-10a-131 431-10a-132 431-10a-133 431-10a-140 431-10a-201 431-10a-202 431-10a-203 431-10a-204 431-10a-205 431-10a-206 431-10a-206.5 NextLast modified: October 27, 2016