Bill Text: HI HB914 | 2010 | Regular Session | Introduced
Bill Title: Cover Hawaii Health Care Access Program
Spectrum: Bipartisan Bill
Status: (Introduced - Dead) 2009-05-11 - Carried over to 2010 Regular Session. [HB914 Detail]
Download: Hawaii-2010-HB914-Introduced.html
Report Title:
Cover Hawaii Health Care Access Program
Description:
Creates the cover Hawaii health care access program to provide affordable health care coverage options for uninsured residents that provides coverage for basic and preventive health care services; inpatient hospital, urgent, and emergency care services; and is offered statewide by approved health insurers, health maintenance organizations, and mutual benefit societies.
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HOUSE OF REPRESENTATIVES |
H.B. NO. |
914 |
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TWENTY-FIFTH LEGISLATURE, 2009 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
relating to health insurance.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. The legislature finds that a significant number of state residents are unable to obtain affordable health insurance coverage. The legislature also finds that the existing QUEST program has certain limitations, including less than optimal options for catastrophic and emergency care coverage. Therefore, it is the intent of the legislature to expand the availability of health care options for uninsured residents by developing an affordable health care product that emphasizes coverage for basic and preventive health care services; provides inpatient hospital, urgent, and emergency care services; and is offered statewide by approved health insurers, health maintenance organizations, and mutual benefit societies.
SECTION 2. The Hawaii Revised Statutes is amended by adding a new chapter to be appropriately designated and to read as follows:
"Chapter
COVER HAWAII HEALTH CARE ACCESS PROGRAM
§ -1 Definitions. As used in this chapter:
"Cover Hawaii plan" means a consumer choice benefit plan approved under this chapter that guarantees payment or coverage for specified benefits provided to an enrollee.
"Cover Hawaii plan coverage" means health care services that are covered as benefits under a cover Hawaii plan.
"Cover Hawaii plan entity" means a health insurer, health maintenance organization, or health care provider-sponsored organization that develops and implements a cover Hawaii plan and is responsible for administering the plan and paying all claims for cover Hawaii plan coverage by enrollees.
"Cover Hawaii Plus" means a supplemental insurance product, such as for additional catastrophic coverage or dental, vision, or cancer coverage, approved under this chapter and offered to all enrollees.
"Department" means the department of human services.
"Enrollee" means an individual who has been determined to be eligible for and is receiving health insurance coverage under a cover Hawaii plan.
§ -2 Program. (a) The department shall establish and administer the cover Hawaii health care access program. The general cover Hawaii plan components shall include the following:
(1) Plans shall be offered on a guaranteed-issue basis to enrollees, subject to exclusions for preexisting conditions approved by the department;
(2) Plans shall be portable so that the enrollee remains covered regardless of employment status or the cost-sharing of premiums;
(3) Plans shall provide for cost containment through limits on the number of services, caps on benefit payments, and copayments for services;
(4) A cover Hawaii plan entity shall provide all benefit plan and marketing materials in languages approved by the executive director of the office of language access;
(5) In order to provide for consumer choice, cover Hawaii plan entities shall develop two alternative benefit option plans having different cost and benefit levels, including at least one plan that provides catastrophic coverage;
(6) Plans without catastrophic coverage shall provide coverage options for services including:
(A) Preventive health services, including immunizations, annual health assessments, well-woman and well-care services, and preventive screenings such as mammograms, cervical cancer screenings, and noninvasive colorectal or prostate screenings;
(B) Incentives for routine preventive care;
(C) Office visits for the diagnosis and treatment of illness or injury;
(D) Office surgery, including anesthesia;
(E) Behavioral health services;
(F) Durable medical equipment and prosthetics; and
(G) Diabetic supplies.
(b) Plans providing catastrophic coverage, at a minimum, shall provide coverage options for all of the services listed under subsection (a)(6), but may include coverage options for:
(1) Inpatient hospital stays;
(2) Hospital emergency care services;
(3) Urgent care services; and
(4) Outpatient facility services, outpatient surgery, and outpatient diagnostic services.
(c) All plans shall offer prescription drug benefit coverage, use a prescription drug manager, or offer a discount drug card.
(d) Plan enrollment materials shall provide information in plain language on policy benefit coverage, benefit limits, cost-sharing requirements, and exclusions, including a clear representation of what is not covered in the plan. The enrollment materials shall include a standard disclosure form, adopted by rule by the department in accordance with chapter 91, to be reviewed and executed by all consumers purchasing cover Hawaii plan coverage.
(e) Plans offered through a qualified employer shall meet the requirements of section 125 of the Internal Revenue Code.
(f) Guidelines shall be developed to ensure that cover Hawaii plans meet minimum standards for quality of care and access to care. The department shall ensure that the cover Hawaii plans follow standardized grievance procedures.
(g) Changes in cover Hawaii plan benefits, premiums, and policy forms shall be subject to regulatory oversight by the department as provided by rules adopted in accordance with chapter 91.
(h) The department shall develop a public awareness program to be implemented throughout the State for the promotion of the cover Hawaii health care access program.
(i) Public and private entities may design programs to encourage Hawaii residents to participate in the cover Hawaii health care access program and to encourage employers to co-sponsor some share of cover Hawaii plan premiums for employees.
§ -3 Plan proposals. (a) The department shall announce, no later than September 1, 2009, an invitation to negotiate for cover Hawaii plan entities to design a cover Hawaii plan proposal in which benefits and premiums are specified. The invitation to negotiate shall include guidelines for the review of cover Hawaii plan applications, policy forms, and all associated forms and provide regulatory oversight of cover Hawaii plan advertisement and marketing procedures. A plan shall be disapproved or withdrawn if the plan:
(1) Contains any ambiguous, inconsistent, or misleading provisions or any exceptions or conditions that deceptively affect or limit the benefits purported to be assumed in the general coverage provided by the plan;
(2) Provides benefits that are unreasonable in relation to the premium charged or contains provisions that are unfair or inequitable, that are contrary to the public policy of this State, that encourage misrepresentation, or that result in unfair discrimination in sales practices;
(3) Does not demonstrate that the plan is financially sound and that the applicant is able to underwrite or finance the health care coverage provided;
(4) Does not demonstrate that the applicant and its management are in compliance with the standards required under article 9A or 9C of chapter 431; or
(5) Does not guarantee that enrollees may participate in the cover Hawaii plan entity's comprehensive network of providers, as determined by the department and the contract.
(b) The department shall approve at least one cover Hawaii plan entity having an existing statewide network of providers.
§ -4 License not required. The licensing requirements of chapter 431, article 10A and chapters 432 and 432D shall not apply to a cover Hawaii plan approved under this chapter unless expressly made applicable. However, for the purpose of prohibiting unfair trade practices, cover Hawaii plans shall be considered to be insurance subject to the applicable provisions chapter 431, article 10A except as otherwise provided in this section.
§ -5 Eligibility. Eligibility to enroll in a cover Hawaii plan shall be limited to each resident of this State who meets all of the following requirements:
(1) Is between nineteen and sixty-four years of age, inclusive;
(2) Is not covered by a private insurance policy and is not eligible for coverage through a public health insurance program, such as medicare or medicaid, unless eligibility for coverage lapses due to no longer meeting income or categorical requirements;
(3) Has not been covered by any health insurance program at any time during the six months prior to application, unless coverage under a health insurance program was terminated within the previous six months due to:
(A) Loss of a job that provided an employer-sponsored health benefit plan;
(B) Exhaustion of coverage that was continued under the Consolidated Omnibus Budget Reconciliation Act of 1985 or continuation-of-coverage requirements;
(C) Reaching the limiting age under the policy; or
(D) Death of, or divorce from, a spouse who was provided an employer-sponsored health benefit plan; and
(4) Has applied for health care coverage through a cover Hawaii plan and has agreed to make any payments required for participation, including periodic payments or payments due at the time health care services are provided.
§ -6 Records. Each cover Hawaii plan shall maintain enrollment data and provide network data and reasonable records to enable the department to monitor plans and to determine the financial viability of the cover Hawaii plan, as necessary.
§ -7 Nonentitlement. Coverage under a cover Hawaii plan is not an entitlement, and a cause of action does not arise against the State, a county, any other political subdivision of the State, or the department for failure to make coverage available to eligible persons under this chapter.
§ -8 Program evaluation. The department shall:
(1) Evaluate the cover Hawaii health care access program and its effect on the entities that seek approval as cover Hawaii plans, on the number of enrollees, and on the scope of the health care coverage offered under a cover Hawaii plan;
(2) Provide an assessment of the cover Hawaii plans and their potential applicability in other settings;
(3) Use cover Hawaii plans to gather more information to evaluate low-income, consumer-driven benefit packages; and
(4) Submit by September 1, 2010, and annually thereafter, a report to the governor, the president of the senate, and the speaker of the house of representatives that provides the information specified in paragraphs (1) through (3) and recommendations relating to the successful implementation and administration of the program.
§ -9 Rules. The
department shall adopt rules in accordance with chapter 91 to carry out the purposes
of this chapter."
SECTION 3. This Act shall take effect upon its approval.
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INTRODUCED BY: |
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