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Hawaii Health Insurance
Health insurance is an inevitable option that cannot be avoided. Purchasing appropriate health insurance coverage for your family is expensive that requires a good evaluation of all future risks and its impact on your finances. More than 47 million Americans are uninsured, majority of whom are working families. These working families, especially children, end up paying the price for the lack of proper health coverage and the costs associated with them. However, for those families who are not covered by their employers’ health group plan, there are low-priced state sponsored health insurance programs.
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 | |
Phone Number | 808-587-3521 (Oahu) |
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 | |
Phone Number | 800-316-8005 |
Residency Requirements | Hawaii resident, legal citizen, qualified immigrant |
Federal Poverty Line Income Limits | Infants (ages 0-19): 300% FPL |
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.
