2013 Hawaii Revised Statutes
TITLE 24. INSURANCE
431. Insurance Code
431:10A-116.6 Contraceptive services.

Note

Article heading amended by L 2002, c 155, §48.

Health care transformation program within the office of the governor (terminated July 1, 2015); reports to 2014-2015 legislature. L 2013, c 224.

Prescription drug benefits, mail order opt out; reports to 2014-2015 legislature; applicability. L 2013, c 226, §§4, 5.

Cross References

Conformance to federal law, see §431:2-201.5.

Federally qualified health centers; rural health clinics; reimbursement, see §346-53.6.

Health maintenance organization act, see chapter 432D.

Medicaid-related mandates, see chapter 431L.

Mental health and alcohol and drug abuse treatment insurance benefits, see chapter 431M.

Patients' bill of rights and responsibilities act, see chapter 432E.

Prescription drug benefits, see chapter 431R.

Prescription drugs; mail order opt out option, see §87A-16.3.

Proposed mandatory health insurance coverage and assessment report, see §§23-51, 52.

State health insurance program, see chapter 431N.

Attorney General Opinions

Section 431:10A-601 applied to all parts of article 10A if the category of policy under consideration included family coverage, as defined in §431:10A-103. Att. Gen. Op. 97-10.

The placement of §431:10A-601 in this article, regulating content of insurance contracts, makes clear that the legislative intent was to mandate benefits that must be made available by insurers that write contracts of insurance providing family coverage. Att. Gen. Op. 97-10.

Law Journals and Reviews

Tax Justice and Same-Sex Domestic Partner Health Benefits: An Analysis of the Tax Equity For Health Plan Beneficiaries Act. 32 UH L. Rev. 73 (2009).

Case Notes

As chapter 432D does not cover the field of managed care regulation and because §§432D-2, 432E-1, and this article can be read together and there is no explicit language or policy reason not to give each statute effect, chapter 432D does not repeal chapter 432E by implication. 126 H. 326, 271 P.3d 621 (2012).

Properly licensed HMOs, like plaintiff, were authorized pursuant to §432D-1 to "provide or arrange", at their option, for the closed panel health care services required under the managed care plan program; accident and health insurers were authorized under §431:10A-205(b) to arrange for medical services for members using a defined network of providers, i.e., particular "hospitals or persons"; thus, this article and chapter 432D authorized both accident and health insurers and HMOs, as risk-bearing entities, to provide the closed panel product required by the managed care plan contracts. 126 H. 326, 271 P.3d 621 (2012).

PART I. INDIVIDUAL ACCIDENT AND HEALTH

OR SICKNESS POLICIES

Note

Part heading amended by L 2002, c 155, §48.

Attorney General Opinions

Section 431:10A-601 applied to all parts of article 10A if the category of policy under consideration included family coverage, as defined in §431:10A-103. Att. Gen. Op. 97-10.

Case Notes

Under this article and §431:10A-105(2)(A)(ii), standard "incontestability clause" of contract precluded insurer from denying insured "total disability benefit" contracted for, notwithstanding that HIV infection that caused the disability arguably "manifested" itself prior to policy's effective date of coverage. 86 H. 262, 948 P.2d 1103.

§431:10A-116.6 Contraceptive services. (a) Notwithstanding any provision of law to the contrary, each employer group accident and health or sickness policy, contract, plan, or agreement issued or renewed in this State on or after January 1, 2000, shall cease to exclude contraceptive services or supplies for the subscriber or any dependent of the subscriber who is covered by the policy, subject to the exclusion under section 431:10A-116.7.

(b) Except as provided in subsection (c), all policies, contracts, plans, or agreements under subsection (a), that provide contraceptive services or supplies, or prescription drug coverage, shall not exclude any prescription contraceptive supplies or impose any unusual copayment, charge, or waiting requirement for such supplies.

(c) Coverage for oral contraceptives shall include at least one brand from the monophasic, multiphasic, and the progestin-only categories. A member shall receive coverage for any other oral contraceptive only if:

(1) Use of brands covered has resulted in an adverse drug reaction; or

(2) The member has not used the brands covered and, based on the member's past medical history, the prescribing health care provider believes that use of the brands covered would result in an adverse reaction.

(d) For purposes of this section:

"Contraceptive services" means physician-delivered, physician-supervised, physician assistant–delivered, nurse practitioner-delivered, certified nurse midwife-delivered, nurse-delivered, or pharmacist-delivered medical services intended to promote the effective use of contraceptive supplies or devices to prevent unwanted pregnancy.

"Contraceptive supplies" means all United States Food and Drug Administration-approved contraceptive drugs or devices used to prevent unwanted pregnancy.

(e) Nothing in this section shall be construed to extend the practice or privileges of any health care provider beyond that provided in the laws governing the provider's practice and privileges. [L 1993, c 365, §1; am L 1999, c 267, §2; am L 2003, c 201, §3 and c 212, §73]