REPORT TITLE:
Health Insurance


DESCRIPTION:
Requires health insurance policies to reimburse for emergency
aeromedical services.  Requires the Legislative Auditor to
conduct a study assessing the social and financial effects of
mandating health coverage for emergency services rendered by
helicopter aeromedical services.  (HB894 HD2)

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
                                                        894
HOUSE OF REPRESENTATIVES                H.B. NO.           H.D. 2
TWENTIETH LEGISLATURE, 1999                                
STATE OF HAWAII                                            
                                                             
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                   A  BILL  FOR  AN  ACT

RELATING TO HEALTH INSURANCE REIMBURSEMENTS. 


BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:

 1      SECTION 1.  Chapter 432D, Hawaii Revised Statutes, is
 
 2 amended by adding a new section to part VI to be appropriately
 
 3 designated and to read as follows:
 
 4      "432D-    Coverage and reimbursement for emergency
 
 5 aeromedical services.  All individual and group hospital and
 
 6 medical service plan contracts and medical service corporation
 
 7 contracts under this chapter shall provide coverage and
 
 8 reimbursement for emergency services rendered by helicopter
 
 9 aeromedical services."
 
10      SECTION 2.  Section 431:10A-116, Hawaii Revised Statutes, is
 
11 amended to read as follows:
 
12      "431:10A-116  Coverage for specific services.  Every person
 
13 insured under a policy of accident and sickness insurance
 
14 delivered or issued for delivery in this State shall be entitled
 
15 to the reimbursements and coverages specified below:
 
16      (1)  Notwithstanding any provision to the contrary, whenever
 
17           a policy, contract, plan, or agreement provides for
 
18           reimbursement for any visual or optometric service
 
19           which is within the lawful scope of practice of a duly
 
20           licensed optometrist, the person entitled to benefits
 

 
Page 2                                                     894
                                     H.B. NO.           H.D. 2
                                                        
                                                        

 
 1           or the person performing the services shall be entitled
 
 2           to reimbursement whether the service is performed by a
 
 3           licensed physician or by a licensed optometrist.
 
 4           Visual or optometric services shall include eye or
 
 5           visual examination, or both, or a correction of any
 
 6           visual or muscular anomaly, and the supplying of
 
 7           opthalmic materials, lenses, contact lenses,
 
 8           spectacles, eyeglasses, and appurtenances thereto[.];
 
 9      (2)  Notwithstanding any provision to the contrary, for all
 
10           policies, contracts, plans, or agreements issued on or
 
11           after May 30, 1974, whenever provision is made for
 
12           reimbursement or indemnity for any service related to
 
13           surgical or emergency procedures which is within the
 
14           lawful scope of practice of any practitioner licensed
 
15           to practice medicine in this State, reimbursement or
 
16           indemnification under such policy, contract, plan, or
 
17           agreement shall not be denied when such services are
 
18           performed by a dentist acting within the lawful scope
 
19           of the dentist's license[.];
 
20      (3)  Notwithstanding any provision to the contrary, whenever
 
21           the policy provides reimbursement or payment for any
 
22           service which is within the lawful scope of practice of
 
23           a psychologist licensed in this State, the person
 

 
Page 3                                                     894
                                     H.B. NO.           H.D. 2
                                                        
                                                        

 
 1           entitled to benefits or performing the service shall be
 
 2           entitled to reimbursement or payment, whether the
 
 3           service is performed by a licensed physician or
 
 4           licensed psychologist[.];
 
 5      (4)  Notwithstanding any provision to the contrary, each
 
 6           policy, contract, plan, or agreement issued on or after
 
 7           February 1, 1991, except for policies which only
 
 8           provide coverage for specified diseases or other
 
 9           limited benefit coverage, but including policies issued
 
10           by companies subject to chapter 431, article 10A, part
 
11           II and chapter 432, article 1 shall provide coverage
 
12           for screening by low-dose mammography for occult breast
 
13           cancer as follows:
 
14           (A)  For women thirty-five to thirty-nine years of age,
 
15                one baseline mammogram;
 
16           (B)  For women forty to forty-nine years of age, a
 
17                mammogram every two years;
 
18           (C)  For women fifty years of age and older, an annual
 
19                mammogram; and
 
20           (D)  For a woman of any age with a history of breast
 
21                cancer or whose mother or sister has had a history
 
22                of breast cancer, a mammogram upon the
 
23                recommendation of the woman's physician.
 

 
Page 4                                                     894
                                     H.B. NO.           H.D. 2
                                                        
                                                        

 
 1                The services provided in this paragraph are
 
 2                subject to any coinsurance provisions which may be
 
 3                in force in these policies, contracts, plans, or
 
 4                agreements.  The commissioner shall annually
 
 5                review the age and frequency guidelines for
 
 6                mammographic screening recommended by the American
 
 7                Cancer Society, and shall accordingly adjust the
 
 8                age and frequency requirements under subparagraphs
 
 9                (A) to (C) by rule, if necessary.
 
10                For the purpose of this paragraph, the term "low-
 
11                dose mammography" means the x-ray examination of
 
12                the breast using equipment dedicated specifically
 
13                for mammography, including but not limited to the
 
14                x-ray tube, filter, compression device, screens,
 
15                films, and cassettes, with an average radiation
 
16                exposure delivery of less than one rad mid-breast,
 
17                with two views for each breast.  An insurer may
 
18                provide the services required by this paragraph
 
19                through contracts with providers; provided that
 
20                the contract is determined to be a cost-effective
 
21                means of delivering the services without sacrifice
 
22                of quality and meets the approval of the director
 
23                of health[.];
 

 
Page 5                                                     894
                                     H.B. NO.           H.D. 2
                                                        
                                                        

 
 1      (5)  (A)  (i)  Notwithstanding any provision to the
 
 2                     contrary, whenever a policy, contract, plan,
 
 3                     or agreement provides coverage for the
 
 4                     children of the insured, that coverage shall
 
 5                     also extend to the date of birth of any
 
 6                     newborn child to be adopted by the insured;
 
 7                     provided that the insured gives written
 
 8                     notice to the insurer of the insured's
 
 9                     intent to adopt the child prior to the
 
10                     child's date of birth or within thirty days
 
11                     after the child's birth or within the time
 
12                     period required for enrollment of a natural
 
13                     born child under the policy, contract plan,
 
14                     or agreement of the insured, whichever period
 
15                     is longer; provided, however, if the adoption
 
16                     proceedings are not successful, the insured
 
17                     shall reimburse the insurer for any expenses
 
18                     paid for the child[.]; and
 
19               (ii)  Where notification has not been received by
 
20                     the insurer prior to the child's birth or
 
21                     within the specified period following the
 
22                     child's birth, insurance coverage shall be
 
23                     effective from the first day following the
 

 
Page 6                                                     894
                                     H.B. NO.           H.D. 2
                                                        
                                                        

 
 1                     insurer's receipt of legal notification of
 
 2                     the insured's ability to consent for
 
 3                     treatment of the infant for whom coverage is
 
 4                     sought[.];
 
 5           (B)  When the insured is a member of a health
 
 6                maintenance organization (HMO), coverage of an
 
 7                adopted newborn is effective:
 
 8                (i)  From the date of birth of the adopted newborn
 
 9                     when the newborn is treated from birth
 
10                     pursuant to a provider contract with the
 
11                     health maintenance organization, and written
 
12                     notice of enrollment in accord with the
 
13                     health maintenance organization's usual
 
14                     enrollment process is provided within thirty
 
15                     days of the date the insured notifies the
 
16                     health maintenance organization of the
 
17                     insured's intent to adopt the infant for whom
 
18                     coverage is sought; or
 
19               (ii)  From the first day following receipt by the
 
20                     health maintenance organization of written
 
21                     notice of the insured's ability to consent
 
22                     for treatment of the infant for whom coverage
 
23                     is sought and enrollment of the adopted
 

 
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                                     H.B. NO.           H.D. 2
                                                        
                                                        

 
 1                     newborn in accord with the health maintenance
 
 2                     organization's usual enrollment process if
 
 3                     the newborn has been treated from birth by a
 
 4                     provider not contracting or affiliated with
 
 5                     the health maintenance organization[.];
 
 6           and
 
 7      (6)  Notwithstanding any provision to the contrary, each
 
 8           policy, contract, plan, or agreement issued or renewed
 
 9           in this state shall provide coverage and reimbursement
 
10           for emergency services rendered by helicopter
 
11           aeromedical services."
 
12      SECTION 3.  (a)  The legislative auditor shall conduct a
 
13 study assessing the social and financial impact of mandating
 
14 hospital and individual health plan contracts to provide coverage
 
15 and reimbursement for emergency services rendered by helicopter
 
16 aeromedical services.
 
17      (b)  The legislative auditor shall report the findings and
 
18 recommendations to the legislature no later than twenty days
 
19 prior to the convening of the regular session of 2000.
 
20      SECTION 4.  Statutory material to be repealed is bracketed.
 
21 New statutory material is underscored.
 
22      SECTION 5.  This Act shall take effect upon its approval.