TWENTY-EIGHTH LEGISLATURE, 2015
STATE OF HAWAII
A BILL FOR AN ACT
RELATING TO HEALTH INSURANCE.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 14G to be appropriately designated and to read as follows:
"§431:14G- Rerating. No person, business, or entity may change or rerate any rate approved by the commissioner in any subsequent transfer, sale, resale, or pass through of health insurance issued by a managed care plan."
SECTION 2. Chapter 432, Hawaii Revised Statutes, is amended by adding to article 1 a new section to be appropriately designated and to read as follows:
"§432:1- Suspension, revocation, or denial of certificate of authority. (a) Any certificate of authority issued under this chapter may be suspended or revoked and any application for a certificate of authority may be denied if the commissioner finds that any of the conditions listed below exists:
(1) The mutual benefit society is operating significantly in contravention of its basic organizational document or in a manner contrary to that described in any other information submitted under section 432:1-301, unless amendments to the submissions have been filed with and approved by the commissioner;
(2) The mutual benefit society is no longer financially responsible and may reasonably be expected to be unable to meet its obligations to its members and beneficiaries or prospective members;
(3) The mutual benefit society has failed to correct, within the time prescribed by subsection (c), any deficiency occurring due to the mutual benefit society's prescribed minimum net worth being impaired;
(4) The mutual benefit society, or any person on its behalf, has advertised or merchandised its services in an untrue, misrepresentative, misleading, deceptive, or unfair manner;
(5) The continued operation of the mutual benefit society would be hazardous to its members; or
(6) The mutual benefit society has otherwise failed to substantially comply with this chapter.
(b) In addition to, or in lieu of, suspension or revocation of a certificate of authority pursuant to this section, the commissioner may levy an administrative fine upon the mutual benefit society in an amount not less than $500 and not more than $50,000 pursuant to section 431:3-221.
(c) The following shall pertain when insufficient net worth is maintained:
(1) Whenever the commissioner finds that the net worth maintained by any mutual benefit society subject to this chapter is less than the minimum net worth required, the commissioner shall give written notice to the mutual benefit society of the amount of the deficiency and require the mutual benefit society to:
(A) File with the commissioner a plan for correction of the deficiency acceptable to the commissioner; and
(B) Correct the deficiency within a reasonable time, not to exceed sixty days, unless an extension of time, not to exceed sixty additional days, is granted by the commissioner. The deficiency shall be deemed an impairment, and failure to correct the impairment in the prescribed time shall be grounds for suspension or revocation of the certificate of authority or for placing the mutual benefit society in conservation, rehabilitation, or liquidation; and
(2) Unless allowed by the commissioner, no mutual benefit society or person acting on its behalf, directly or indirectly, may renew, issue, or deliver any certificate, agreement, or contract of coverage in this State for which a premium is charged or collected, when the mutual benefit society writing the coverage is impaired and the fact of the impairment is known to the mutual benefit society or to the person; provided that the existence of an impairment shall not prevent the issuance or renewal of a certificate, agreement, or contract when the member exercises an option granted under the plan to obtain a new, renewed, or converted coverage.
(d) A certificate of authority shall be suspended or revoked, an application for a certificate of authority denied, or an administrative fine imposed, only after compliance with the requirements of this section, including the following:
(1) Suspension or revocation of a certificate of authority, denial of an application, or imposition of an administrative fine pursuant to this section shall be by written order and shall be sent to the mutual benefit society or applicant by certified or registered mail. The written order shall state the grounds, charges, or conduct on which suspension, revocation, denial, or administrative penalty is based. The mutual benefit society or applicant, in writing, may request a hearing pursuant to section 431:2-308; and
(2) If the mutual benefit society or applicant requests a hearing pursuant to this section, the commissioner shall issue a written notice of hearing and send it to the mutual benefit society or applicant by certified or registered mail and to the director of labor and industrial relations stating:
(A) A specific time for the hearing, which may not be less than twenty nor more than thirty days after mailing of the notice of hearing; and
(B) A specific place for the hearing.
(e) When the certificate of authority of a mutual benefit society is suspended, the mutual benefit society shall not, during the period of the suspension, enroll any additional members except newborn children or other newly acquired dependents of existing members and shall not engage in any advertising or solicitation whatsoever.
(f) When the certificate of authority of a mutual benefit society is revoked, the society, immediately following the effective date of the order of revocation, shall proceed to wind up its affairs and shall conduct no further business except as may be essential to the orderly conclusion of the affairs of the society. The mutual benefit society shall engage in no further advertising or solicitation whatsoever. The commissioner, by written order, may permit further operation of the society as the commissioner may find to be in the best interest of the members, to the end that members will be afforded the greatest practical opportunity to obtain continuing coverage and benefits."
SECTION 3. Chapter 431M, Hawaii Revised Statutes, is amended by amending its title to read as follows:
HEALTH AND ALCOHOL AND [
DRUG ABUSE] SUBSTANCE USE DISORDER
TREATMENT INSURANCE BENEFITS"
SECTION 4. Section 431M-1, Hawaii Revised Statutes, is amended as follows:
1. By amending the definition of "partial hospitalization services" to read:
""Partial hospitalization [
means treatment services, including in-hospital treatment services or benefits,
provided by a hospital or mental health outpatient facility to patients who,
because of their conditions, require more than periodic hourly service.
Partial hospitalization [ services] shall be prescribed by a physician or
psychologist, and may be prescribed by a licensed clinical social worker,
marriage and family therapist, licensed mental health counselor, or advanced
practice registered nurse in consultation with a physician or psychologist.
Partial hospitalization [ services require] requires less than
twenty-four hours of care and a minimum of three hours in any one day."
2. By repealing the definition of "serious mental illness".
"Serious mental illness"
means a mental disorder consisting of at least one of the following:
schizophrenia, schizo-affective disorder, bipolar types I and II, obsessive
compulsive disorder, dissociative disorder, delusional disorder, and major
depression, as defined in the most recent version of the Diagnostic and
Statistical Manual of the American Psychiatric Association and which is of
sufficient severity to result in substantial interference with the activities
of daily living."]
SECTION 5. Section 432E-1, Hawaii Revised Statutes, is amended by amending the definition of "emergency services" to read as follows:
""Emergency services" means services provided to an enrollee when the enrollee has symptoms of sufficient severity, including severe pain, such that a layperson could reasonably expect, in the absence of medical treatment, to result in placing the enrollee's health or condition in serious jeopardy, serious impairment of bodily functions, serious dysfunction of any bodily organ or part, or death."
SECTION 6. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 7. This Act shall take effect upon its approval.
Insurance; Health Insurance; Rate Regulation; Certificate of Authority
Updates title 24 of the Hawaii Revised Statutes, relating to insurance, by: specifying that rerating of rates approved by the insurance commissioner is prohibited; permitting the suspension, revocation, or denial of a mutual benefit society's certificate of authority under certain conditions; and making other conforming amendments. (SD1)
The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.