Federal & State Regulations | Health plans - Hawaii | J. J. Keller® Compliance Network

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Summary of differences between federal and state regulations

Employee health plans are generally covered under the federal jurisdiction of the Employee Retirement Income Security Act (ERISA).

Federal ERISA plans generally do not have to comply with state laws. ERISA rules preempt or block state laws that relate to ERISA plans. State insurance laws, however, do apply.

Hawaii has laws governing health insurance; some of the provisions are as follows:

Newborns and adopted children are covered at birth or adoption (for plans that provide family coverage).
Child health supervision services are covered from the moment of birth through age five years.
Coverage includes services performed by a licensed optometrist, dentist, psychologist, advanced practice registered nurses, telehealth (real-time video conferencing, secure web-based communication, etc, used to deliver health and health care services). A doctor-patient relationship must exist between the patient and one of the physicians involved in telehealth consultation in order to be reimbursed.
Coverage for medical foods and low-protein modified food products.
Coverage for outpatient diabetes self-management training, education, equipment, and supplies.
Group health plans that include coverage or benefits for cancer treatment must cover medically necessary chemotherapy, including orally administered chemotherapy at the same copay percent or relative coinsurance amount as is applied to intravenously administered chemotherapy.
Group plans issued or renewed in Hawaii after January 1, 2016 must provide to the policyholder and individuals under 14 years of age covered under the policy coverage for the diagnosis and treatment of autism. Insurers must provide written notice to their policyholders regarding this coverage. The notice must be in writing and prominently positioned in any literature or correspondence sent to policyholders and must be transmitted to policyholders within calendar year 2016 when annual information is made available to policyholders or in any other mailing to policyholders, but in no case later than December 31, 2016.
Effective for plans issued or renewed on or after 1/1/17, plans are prohibited from discriminating against anyone on the basis of actual gender identity or perceived gender identity. (HB 2084, Act 135)

Hawaii also has a law, Hawaii Prepaid Health Care Act, governing group prepaid health care plans. Employers must provide to their employees medical and hospital care for nonwork-related injuries and illnesses by:

Purchasing an approved health care plan from a health care contractor,
Adopting an approved self-insured health care plan, or
Negotiating a collective bargaining agreement that provides health care benefits at least equivalent as those required by the Act.

State law indicates that plans are to comply with the consumer protection and market reforms provisions of the federal Patient Protection and Affordable Care Act.