Hawaii Revised Statutes 432d. Health Maintenance Organization Act
- 432d-1 Definitions.
For purposes of this chapter: "Basic health care services" means the following medical services: preventive care, emergency care, inpatient and outpatient hospital and physician...
- 432d-1.5 Bona Fide Trade Associations.
(a) At the option of a bona fide trade association, or its designated agent, a health maintenance organization that sells health insurance to the bona...
- 432d-2 Establishment of Health Maintenance Organizations.
(a) Any person may apply to the commissioner for a certificate of authority to establish and operate a health maintenance organization in compliance with...
- 432d-3 Powers of Health Maintenance Organizations.
(a) The powers of a health maintenance organization include the following: (1) Purchase, lease, construction, renovation, operation, or maintenance of hospitals, medical facilities, or...
- 432d-4 Fiduciary Responsibilities.
(a) Any director, officer, employee, or partner of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities...
- 432d-5 Annual and Quarterly Reports.
(a) Every health maintenance organization shall file annually, on or before March 1, a report verified by at least two principal officers covering the...
- 432d-6 Information to Enrollees or Subscribers.
(a) The health maintenance organization shall provide to its subscribers a list of providers and participating providers, upon enrollment and reenrollment. (b) Every health...
- 432d-7 Investments.
All investments permitted under section 432D-3(a)(1) may be considered admitted assets in determination of net worth; provided that these investments are in compliance with...
- 432d-8 Protection Against Insolvency.
(a) Net worth requirements are as follows: (1) Before issuing any certificate of authority, the commissioner shall require that the health maintenance organization has an...
- 432d-9 Uncovered Expenditures Insolvency Deposit.
(a) If, at any time, uncovered expenditures exceed ten per cent of total health care expenditures, a health maintenance organization shall place with the...
- 432d-9.5 Reserve Credit for Reinsurance.
Any health maintenance organization that takes credit for reserves on risks ceded to a reinsurer shall be subject to provisions of chapter 431 related...
- 432d-10 Enrollment Period.
(a) In the event of an insolvency of a health maintenance organization, upon order of the commissioner, all other carriers offered as alternatives to...
- 432d-11 Replacement Coverage.
(a) For purposes of this chapter, "discontinuance" means the termination of the contract between the group contract holder and a health maintenance organization due to...
- 432d-12 Powers of Insurers and Hospital and Medical Service Corporations.
(a) An insurance company licensed in this State, or a hospital or medical service corporation authorized to do business in this State, either directly...
- 432d-13 Examinations.
(a) The commissioner may examine the affairs of any health maintenance organization or of any providers with whom such organization has contracts, agreements, or...
- 432d-14 Suspension, Revocation, or Denial of Certificate of Authority.
(a) Any certificate of authority issued under this chapter may be suspended or revoked, and any application for a certificate of authority may be...
- 432d-15 Rehabilitation, Liquidation, or Conservation of Health Maintenance Organizations.
(a) Any rehabilitation, liquidation, or conservation of a health maintenance organization shall be deemed to be the rehabilitation, liquidation, or conservation of an insurance...
- 432d-16 Summary Orders and Supervision.
(a) Whenever the commissioner determines that the financial condition of any health maintenance organization is such that its continued operation might be hazardous to...
- 432d-17 Fees
. (a) The commissioner shall collect, in advance, the following fees: (1) Certificate of authority: (A) Application for a certificate of authority: $900; and (B)...
- 432d-18 Penalties and Enforcement.
(a) The commissioner, in lieu of suspension or revocation of a certificate of authority, may impose an administrative fine pursuant to section 432D-14(b). (b) If...
- 432d-18.5 Repealed.
L 2009, c 149, §13. Cross References Insurance fraud, see §§431:2-401 to 431:2-410.
- 432d-19 Statutory Construction and Relationship to Other Laws.
(a) Except as provided in subsection (d) and otherwise provided in this chapter, the insurance laws and hospital or medical service corporation laws shall...
- 432d-20 Filings and Reports As Public Documents.
Notwithstanding chapter 92F and any other laws to the contrary, all applications and filings required under this chapter shall be treated as public, except...
- 432d-21 Confidentiality of Medical Information.
Any data or information pertaining to the diagnosis, treatment, or health of any enrollee or applicant obtained from such person or from any provider...
- 432d-22 Acquisition of Control of or Merger of a Health Maintenance Organization.
No person may make a tender for or a request or invitation for tenders of, enter into an agreement to exchange securities for, or...
- 432d-23 Required Provisions and Benefits.
Notwithstanding any provision of law to the contrary, each policy, contract, plan, or agreement issued in the State after January 1, 1995, by health...
- 432d-23.5 Coverage for Telehealth.
(a) It is the intent of the legislature to recognize the application of telehealth as a reimbursable service by which an individual shall receive...
- 432d-23.6 Federally Funded Programs; Exemption.
Requirements relating to mandated coverages shall not be applicable to any health maintenance organization offering health insurance under a federally funded program under the...
- 432d-24 Coordination of Benefits.
(a) Health maintenance organizations are permitted, but not required to adopt provisions for coordination of benefits to avoid overinsurance and to provide for the...
- 432d-25 Disclosure of Health Care Coverage and Benefits.
In order to ensure that all individuals understand their health care options and are able to make informed decisions, all health maintenance organizations shall...
- 432d-26 Genetic Information Nondiscrimination in Health Insurance Coverage.
(a) No health maintenance organization may: (1) Use an individual's or a family member's genetic information, or request for genetic services, to deny or...
- 432d-27 Policies Relating to Domestic Abuse Cases.
(a) No health maintenance organization shall deny or refuse to accept an application for insurance, refuse to insure, refuse to renew, cancel, restrict, or...
- 432d-28 Federal Law Compliance.
A health maintenance organization shall comply with applicable federal law. The commissioner shall enforce the consumer protections and market reforms relating to insurance as...
- 432d-29 Prohibition on Rescissions of Coverage.
(a) Notwithstanding sections 431:10-226.5 and 431:10A-106 to the contrary, a health maintenance organization shall not rescind coverage under a health benefit plan with respect...
Last modified: October 27, 2016