Report Title:

HMO Choice of Provider; Any Willing Provider

Description:

Requires HMOs to offer enrollees a plan to choose any willing health care provider without referral or prior HMO authorization if the provider is located in the same county and agrees to HMO terms and conditions. Allows HMO to impose higher deductible, copayment, and insurance premium for the plan.

HOUSE OF REPRESENTATIVES

H.B. NO.

2536

TWENTY-SECOND LEGISLATURE, 2004

 

STATE OF HAWAII

 


 

A BILL FOR AN ACT

 

relating to health maintenance organizations.

 

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

SECTION 1. Chapter 432D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:

"§432D-    Any willing provider; enrollment. (a) A health maintenance organization operating in the State shall offer to each of its enrollees a point-of-service plan option that allows a covered individual to receive covered services from a licensed health care provider in the State who is outside the health maintenance organization's network, without obtaining a referral or prior authorization from the health maintenance organization; provided that:

(1) The point-of-service plan option may require that an enrollee pay a higher deductible or copayment and higher premium for the plan; and

(2) The health care provider chosen by the enrollee is:

(A) Located in the same county as the enrollee; and

(B) Willing to meet the terms and conditions, including schedule of fees, covered expenses, utilization regulations, and quality standards, established by the health maintenance organization, to provide services to the enrollee.

For the purposes of this section, the term "health care provider" means an individual licensed or certified to provide health care in the ordinary course of business or practice of a profession.

(b) A health maintenance organization shall provide each enrollee with an opportunity at the time of enrollment and during the annual open enrollment period to enroll in the point-of-service plan option. The health maintenance organization shall provide a written notice of the point-of-service plan option to each enrollee and shall include in that notice a detailed explanation of the financial costs to be incurred by an enrollee who selects that option."

SECTION 2. New statutory material is underscored.

SECTION 3. This Act shall take effect upon its approval.

INTRODUCED BY:

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