2014 Hawaii Revised Statutes
TITLE 24. INSURANCE
431. Insurance Code
431:10A-117 Franchise plan.

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, 8.

State innovation waiver task force; health care reform plan; reports to 2015-2017 legislature (dissolved June 30, 2017). L 2014, c 158.

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-117 Franchise plan. (a) As used in this section, "employees" include:

(1) The officers, managers, and employees of the employer; and

(2) The individual proprietor or partners, if the employer is an individual proprietor or partnership.

(b) Insurance may be issued pursuant to this part on a franchise plan under the terms of which accident and health or sickness insurance is issued to:

(1) Five or more employees of any corporation, co-partnership, or individual employer, or any governmental corporation, agency, or department thereof; or

(2) Ten or more members, employees, or employees of members of any trade or professional association, of a labor union, or of any other association having had an active existence for at least two years; provided that:

(A) Such association or union has a constitution or bylaws and is formed in good faith for purposes other than that of obtaining insurance;

(B) Such persons, with or without their dependents, are issued the same form of an individual policy varying only as to amounts and kinds of coverage applied for; and

(C) There is an arrangement whereby the premiums on the policies may be paid to the insurer periodically by the employer, with or without payroll deductions, or by the association for its members, or by some designated person acting on behalf of the employer or association. [L 1987, c 347, pt of §2; am L 2002, c 155, §57; am L 2004, c 122, §33]