Hawaii Health Insurance Policies and Information

Health Insurance in Hawaii

The majority of Hawaii residents obtain their health coverage through an employer. This is because of a law known as the Prepaid Health Care Act that requires employers to provide health insurance to employees after working at least 20 hours per week for four consecutive weeks and earning 86.67 times the Hawaii minimum wage per month ($7.25 x 86.67 = $628).

Group vs. Individual

If you receive your health insurance through an employer, you have group coverage. In general, group coverage provides significantly more protections than does individual coverage.

Group

• Cannot impose preexisting condition exclusion
• Employer groups are guaranteed issue and cannot be turned down because of the health status, age, or any factor that might predict the use of health services of those in the group.
• Guaranteed renewable
• Premiums may vary based on the health status of others in the group along with other factors
• Professional or trade associations may purchase group plans

HIPAA

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) is a Federal law that guarantees access to individual policies for individuals leaving group plans that have had at least 18 months of previous coverage (the last of which was through a group plan). To exercise this right to an individual policy you must apply for one within 63 days from your last day of coverage through your group plan. HIPAA also established a privacy rule for a national standard to protect the privacy of personal health information.

Individual

• If you are HIPAA eligible, health insurers that sell individual policies must offer you a choice of at least two plans that they sell; (1) they must allow you to buy any individual health policy and (2) they cannot impose pre-existing condition exclusions.
• If you are not HIPAA eligible, individual health insurers in Hawaii are free to turn you down because of your health status and other factors.
• Policies may include an elimination period where no benefits will be paid.
• Policies may exclude pre-existing conditions for a period of time.
• The law does not limit what you can be charged for individual health insurance policy and you can be charged substantially higher premiums because of your health status, age, gender, and other factors.
• Insurers are not required to sell standardized policies; they can design different policies and you should read and compare them carefully before any selection.