Hawaii Health Insurance Coverage...

If you are searching for ways to lower your health insurance costs and you live in the State of Hawaii...We, here at HealthInsureCoverage.com, work hard to supply you with the information you need to make an informed decision regarding your health insurance needs and requirements.

• What are my protections if I am Self-Employed in Hawaii and I want to purchase Health Insurance?
     Federal law extends certain protections to employers seeking to buy health insurance for themselves and their workers. These reforms complement Hawaii’s requirements that employers provide health benefits. Generally, small employers are those that employ 1-50 employees. Please note that the definitions of small employer and employee are somewhat different under federal and state law. Check with the Hawaii Insurance Division to be sure that you know which protections apply to your group.
• Do insurance companies have to sell me health insurance?
     With few exceptions, small employers cannot be turned down. This is called guaranteed issue. If you employ fewer than 50 people, health insurance companies must sell you any small group health plan they sell to other small employers. The prevalent prepaid group health plans sold by Kaiser and HMSA must be sold on a guaranteed issue basis to employers of any size.
• Your insurance cannot be canceled because someone in your group becomes sick.
     This is called guaranteed renewability and it applies to group plans of all sizes. Insurers can impose other conditions, however. Additionally, they can refuse to renew your coverage for nonpayment of premiums or if you commit fraud. If insurers discontinue an insurance product that you bought, they must give you a chance to buy other plans they sell to groups of your size.
• In general, you can be charged higher premiums based on the health, risk, and demographic characteristics of your group.
     Premiums for the prevalent prepaid group health plans sold by Kaiser and HMSA are based on a community rate. This means that they will not vary based on the health status or any other characteristic of the people in your group.
• In Hawaii, insurers must offer small employers prepaid group health plan which must include certain benefits.
     These benefits include hospitalization, outpatient care, surgical care, physicians’ services, laboratory and x-ray services, substance abuse treatment and maternity care if the employee was enrolled in the plan for 9 months prior to delivery. Standardization helps you compare differences in cost and coverage. Carriers can also offer to sell you non-standardized plans. Most small employers choose to purchase a non-standardized plan.
• If you are self-employed with no other workers, you cannot buy a group health plan.
     Therefore, the laws that protect small employers’ access to group health plans do not apply to you. However, you may be able to join a group health plan through a family member or a professional association that sells group health coverage to other small employers. If not, your access to health insurance is protected by the laws that apply to individuals.
• If you are self-employed and buy your own health insurance, you are eligible to deduct an increasing percentage of the cost of your premium from your federal income tax.
  This deduction is 70% for 2002, and 100% in 2003 and thereafter.
• Some small employers, self-employed people, and other individuals buy health insurance through professional or trade associations.
     The laws applying to association health coverage can be different than those for other health plans. Check with the Hawaii Insurance Division about your protections in association health plans.
• The Medicaid Program.
     Medicaid is a program that includes the Medicaid Fee-for-Service Program and Hawaii QUEST. It provides health coverage to some low-income Hawaii residents and covers families with children and pregnant women, medically needy individuals, the elderly, and people with disabilities, if state and federal guidelines are met. Legal residents who are not U.S. citizens may be eligible for Medicaid. Non-citizens who do not have immigration documents cannot enroll in Medicaid.
     The Medicaid Fee-for-Service program provides coverage for residents who are over the age of 65 or are blind or disabled. Hawaii QUEST is a managed care program that provides coverage for all other eligible persons.
• Families who get cash benefits from TANF can get Medicaid.
     Parents should know that when you get a job and your TANF benefits end, you generally can stay on Medicaid for a 12-month transitional period. Parents should know that when your family’s TANF benefits end, your children may also qualify for transitional Medicaid coverage for 12 months. Or, they may qualify for Medicaid themselves if your family’s income meets the Medicaid income standards.

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