Hawaii Health Insurance Policy Requirements

Hawaii has unique health insurance requirements including the Prepaid Health Care Act.

Regulatory Structure

Hawaii health coverage is regulated by the Insurance Division:

Hawaii Prepaid Health Care Act

Hawaii has the Prepaid Health Care Act (PHCA), a unique employer mandate:

• Enacted in 1974, before ERISA
• Requires employers to provide health insurance to employees
• Employees working 20+ hours/week must be covered
• Employer must pay at least 50% of premium
• More comprehensive than ACA employer mandate

PHCA Requirements

Free Look Period

Hawaii provides a 10-day free look period for individual health insurance:

• Policyholder can return for full premium refund
• Begins when policy is delivered
• Applies to individual health policies

Healthcare.gov Marketplace

Hawaii uses Healthcare.gov, the federal health insurance marketplace:

• Federal enrollment platform for individuals not covered by employer
• Only place to get premium subsidies in Hawaii
• Open enrollment: November 1 - January 15
• Special enrollment periods for qualifying life events
• Premium tax credits available based on income

ACA Compliance in Hawaii

Hawaii's health insurance market operates under both state and federal requirements:

Essential Health Benefits

All individual and small group plans must cover:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorders
6. Prescription drugs
7. Rehabilitative services
8. Laboratory services
9. Preventive and wellness services
10. Pediatric services (including dental and vision)

Pre-Existing Condition Protections

For ACA-compliant plans:

Med-QUEST (Medicaid)

Hawaii's Medicaid program is called Med-QUEST:

• Expanded under the ACA
• Available to adults with income up to 138% FPL
• Managed care delivery system
• Covers comprehensive health services