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Hawaii Health Insurance

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Facts and Figures

  • Place in State
    Health Report Card
  • Insured 1,127,828
  • Uninsured 100,300
  • Insurance
  • Number of
    Primary Care Physicians
  • Number of

Breakdown of Insureds

  • Employer-sponsored health insurance 62%
  • Private plans 3%
  • Medicaid 15%
  • Medicare 16%
  • Others 4%

State Health Report Card

1. Smoking among adults in Hawaii decreased from 19.7% to 14.5% in the past ten years; today, there are 153,000 adult smokers in the state. 2. Preventable hospitalizations is down from 28.6 to 25.6 discharges per 1,000 Medicare enrollees in the past year. 3. Obesity among adults in Hawaii is up from 19.7% to 23.1% over the last five years. There are 244,000 adults living with obesity in Hawaii. 4. The number adults living with diabetes has increased from 7.3% to 8.3% over five years. 5. Children living in poverty increased from 10.0% to 18.9% of under 18 individuals over the last five years.

Hawaii Health Insurance Laws and Regulations

Hawaii health insurance plans must sold with a guaranteed renewability clause. An insurance policy cannot be cancelled as long as the subscriber keeps up with the premium payments. Providers cannot cancel an existing policy because of an illness. If a parent’s policy covers dependents, their newborn or adopted children will be automatically covered for up to 31 days. Premium rates can be based on age, health, and marital status of the subscriber, and because Hawaii lacks major restrictions, prices can vary significantly. Insurers may deny coverage to an applicant who is already ill or who may be at special risk. When writing new Hawaii health insurance plans, insurers can exclude coverage for a pre-existing condition. How long this coverage exemption lasts can vary depending on the plan. Having a continuous health coverage, will allow you to switch to another policy without having to reset the waiting period. Insurance companies in Hawaii can deny an application based solely on the applicants health status. Insurers are not allowed to cancel an existing plan due to health issues. However, they can calculate premium rates based on these grounds. Small businesses in Hawaii can purchase any form of small-business group health insurance available to other companies. However, a minimum number of enrollees may be required depending on the organization’s size and membership. Hawaii health insurance quotes for group coverage can vary according to the risk factors of its members. However, small group health plans cannot be cancelled due to a member’s health condition. Health insurers are permitted to set premium rates for small businesses health insurance based on the age, gender, health, marital status, location, or other related factors of the employees. However, coverage cannot be cancelled based on the based on the employees’ health problems. The state of Hawaii does not allow self-employed individuals to purchase small-business health insurance if they do not have any other employee. They can purchase individual plans instead and with this plan a portion of the premium payment can be deducted from taxes.

The health care services that are required by Hawaii health insurance law to be covered include:

Mammograms for women over 40 years old

Care for diabetes

Alcohol and drug treatment services

Care for mental health conditions

Heath Care Reform

With the new health care law, children under the age of 26 can choose to stay under their parent’s Hawaii health insurance as long as they are not offered an employer-based health insurance. This provision enabled 2.5 million young adults to have insurance nationwide. In Hawaii, more than 5,000 young adults have insurance coverage through this provision as of June 2011.

The new health care law allowed nearly 355,000 Medicare policyholders in Hawaii to receive a $250 rebate check to help with prescription drug costs when they fell into the Medicare gap in 2010. In 2011, around 21,200 Medicare plan holders were given a 50% discount on brand-name prescription drugs covered by their plan when they hit the donut hole. An average of $324 per person or a total of $6,891,588 was saved in Hawaii.

Previously uninsured individuals without health coverage because of a pre-existing condition can now apply for a Pre-Existing Condition Insurance Plan. This plan is available to U.S. citizens or legal residents with a pre-existing condition and have been uninsured for at least 6 months. In 2011, 78 individuals in Hawaii have benefited from this new law.

When looking at Hawaii health insurance quotes, applicants are assured that at least 80 percent of the price will go directly to health care services and other related improvements. A rebate or premium discount shall be provided if the minimum is not met. All private policyholders in Hawaii will get greater value for their premium payments because of this 80/20 rule.

Preventive care services like immunizations, colonoscopies, mammograms, or annual wellness doctor visits must be included in all Hawaii health insurance with no deductibles or co-pays. In 2011, more than 117,800 Medicare subscribers and more than 240,000 individuals with private policies received such services in Hawaii.

Under the new law, insurance companies are no longer allowed to impose an annual dollar limit-a cap on the yearly spending for your benefits, or a lifetime dollar limit-a lifetime cap for spending for your covered benefits. This law frees chronically ill individuals like cancer patients from worrying about getting further treatment because of such limitations. In 2011, more than 462,000 residents in Hawaii have benefited from this law.

If insurance companies want to raise their premium rates by ten percent or more, they are required by federal law to publicly announce and justify their actions. To guard against such unreasonable increases, the state of Hawaii received a total of $4 million.

All fifty states receive increases in funding for community health centers under the Affordable Care Act. This will help construct new health centers, provide medical services to more patients, improve preventive and primary health care services, and fund infrastructure projects. In Hawaii, 73 community health centers received a total of $18.6 million to fund these improvements.

In 2010, the Affordable Care Act created the Prevention and Public Health Fund. This new fund was created for wellness promotion, disease prevention, and protection against public health emergencies. Hawaii has already received a total of $7.1 million to support its policies, programs, and communities to help its residents lead healthier lives.

State Government Insurance Programs Offered


Medicaid offers coverage to low-income individuals and families who cannot pay for their medical care. Applicants for this program should meet financial and other eligibility requirements. Benefits for this program include physician services, inpatient hospital, outpatient services, home health services, dental & vision, laboratory & x-ray, ambulatory surgery centers, non-emergency transportation, nursing, family planning, Early and Periodic Screening, Diagnostic and Treatment (EPSDT) program services, Medicare Premium Assistance, Eligibility: 1. Must be U.S. citizens or legal residents living in Hawaii. 2. Must not exceed income limits.

Hawaii Breast and Cervical Cancer Control Program


The Breast and Cervical Cancer Early Detection Program in Hawaii aims to provide low-income women with free assessment and diagnostic tests. Coverage for treatment may also be included in some cases. This program covers mammograms, Pap tests, breast exams, pelvic exams, and follow-up diagnostic care. Eligibility: 1. Must be women between 50 to 64 years. 2. Must not have insurance or is under-insured 3. Income must not exceed 250% FPL.

Hawaii Medicare


This health care system is administered by the federal government and provides health insurance coverage to Americans aged 65 and above or those younger than 65 but have a disability or end-stage renal disease. Coverage has four parts: Part A: provides inpatient care in hospitals and rehabilitative centers. Part B: provides doctor and some preventive services and outpatient care. Part C: provides Medicare benefits through Medicare Advantage. Part D: provides prescription drug coverage. Eligibility: 1. Must be a U.S. citizen or permanent U.S. resident. 2. Must be 65 years or older, with you or your spouse having worked in a Medicare-covered employment for at least ten years; or have a qualified disability or end-stage renal disease, regardless of age.

Pre-Existing Condition Insurance Plan (PCIP)


The Pre-Existing Condition Insurance aims to provide health insurance to those who have difficulties getting coverage because of a pre-existing condition. Coverage includes a wide range of benefits which includes hospital care, primary care, specialty care, and prescription drugs. Eligibility: 1. Must be a U.S. resident living in Hawaii. 2. Must be uninsured for at least six months. 3. Must have a qualified pre-existing health condition.

Indian Health Service in Hawaii


Indian Health Service (IHS) provides medical and public health services to American Indians and Alaska Natives. IHS provides a broad range of inpatient and outpatient services through health facilities which include hospitals, health centers, field clinics located near population centers. Eligibility Members of a Federally recognized Tribe are eligible for IHS health services. You may qualify if you are not excluded by law, and: 1. Are of Indian and/or Alaska Native descent; or 2. Are an Indian of Canadian or Mexican origin; or 3. Are a non-Indian pregnant woman carrying an eligible Indian’s child. Coverage can be up to 6 weeks post partum; or 4. Are a non-Indian who belongs to an eligible Indian’s household and the medical officer decides that services are needed for public health safety.

Veteran Affairs (VA) Medical Benefits


The Veteran Affairs (VA) Medical Benefits provides standard health benefits plan to veterans enrolled in the program. Benefits are portable and can be accessed anywhere in the VA system. Benefits include preventive and primary care, and a full range of outpatient and inpatient services. Eligibility 1. Must have veteran status.

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