Health Insurance in Hawaii

Health Insurance in Hawaii

Hawaii is the second healthiest state to live in and obtain health coverage as surveyed by the United Health Foundation’s 2008 Health Rankings. The healthcare system of the state has shown a remarkable improvement since the past few years. In 2006, the state was in the 4th spot and climbed up to the 3rd spot in 2007. The state, having the population of more than one million people, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. In addition, the state and federal government sponsored programs provide subsidized health coverage to the uninsurable residents of Hawaii who meet specific eligibility requirements.

The Hawaii Insurance Division of Department of Commerce and Consumer Affairs protects the insurance consumers against unfair practices by regulating all kinds of insurance sold through private-market health insurers as well as public health coverage programs. However, despite of strong public health funding, better access to Hawaiian health care system, nearly 8.3% of the state residents are uninsured. Approximately, 34.4% uninsured Hawaiian citizens come under the above 200% FPL bracket, according to the Censor Bureau’s 2007 and 2008 Current Population Survey.

When shopping for health coverage, get in touch with a local licensed health insurance agent/broker to avail the benefits of health insurance alternatives.

Individual/Family Health Insurance

Below is the guidelines for applying for and obtaining individual health insurance in the state of Hawaii. These regulations apply to all insurance companies offering individual or family health insurance in Hawaii:

Medical Underwriting
Yes
Pre-Existing Condition Exclusion Period
36 months
Look Back Period
No Limit
Look Back Standard
No Definition
Mandatory Benefits
Cancer screening for women including breast cancer, OB/GYNs as primary care providers, infertility coverage, maternity care
Market Rate Restrictions
None
Guaranteed Issue Options
None
Small Group Health Insurance

Below is the guidelines for small group health insurance in the state of Hawaii. These regulations apply to all insurance companies offering small group health insurance in Hawaii:

Small Group Size
1-50
Employee Qualifications
All employers are required to offer coverage to most employees who work 20 hours per week
Guaranteed Issue
Yes
Premium Rating Factors
No Rating Restrictions
Rate Adjustment Factors
Rates must be approved by the state Department of Insurance
Look-Back Period
0
Pre-existing condition exclusionary period
0
Mandatory Benefits
Same as individual
State Cobra Variations for Small Groups

Below are the COBRA guidelines for small groups in the state of Hawaii. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:

Mini-Cobra Option
No
Eligible Group Sizes
NA
Extension of Benefits Period – Standard
NA
Extension of Benefits Period – Disabled
NA
Maximum Premium Increase
NA
State Legislation Reference
NA
Additional Notes
NA
State Sponsored Health Insurance Programs

There are several state sponsored health insurance programs in the State of Hawaii to assist those without insurance in obtaining adequate coverage.

High-Risk Pools

Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. However, Hawaii does not offer high risk pool program to provide health coverage to the medically-uninsurable residents of the state.

Children’s Health Insurance Program

Through shared funding from the federal government, the State of Hawaii provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:

Program Name
Hawai’i Covering Kids
Website
https://www.coveringkidsandfamilies.org/projects/index_StateID=HI.php
Phone Number
808-587-3521 (5Oahu)
Apply Online
Yes
Age Limits
Under 19
Insurance Carrier
AlohaCare, HMSA, Kaiser, and Summerlin
Length of Coverage
12 months
Residency Requirements
Hawaii resident, legal immigrant, refugees
Other Eligibility Requirements
Children should not be eligible to receive health insurance from their employer and not reside in a public institution
Pre-Existing Condition Exclusions
No
Cost
$55 per month
Medicaid

Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Hawaii:

Governing Agency
Med-Quest
Website
https://www.med-quest.us/
Phone Number
800-316-8005
Residency Requirements
Hawaii resident, legal citizen, qualified immigrant
Federal Poverty Line Income Limits
Infants (5ages 0-19): 300% FPL
Pregnant Women: 185% FPL
Parents or the blind, aged or disabled: 100% FPL
Family: At or below 250% qualify for free health insurance
Family: between 250-300% FPL qualify for low cost.
Medically needy: 51% FPL
$2k for a household of one
$3k for a household of two
$250 per additional person
Additional Resources

Hawaii Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Hawaii’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Hawaii: At-A-Glance
Provides exclusive health data of the Hawaii state. Statehealthfacts.org, a project of the Henry J. Kaiser Family Foundation, is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.

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