Enables HEMIC to write basic medical insurance policies for qualified gap income consumers.

A BILL FOR AN ACT

SECTION 1. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 14A to be appropriately designated and to read as follows:

"§431:14A-   Persons eligible to purchase basic health insurance policies from the Hawaii employers' mutual insurance company. The Hawaii employers' mutual insurance company shall establish eligibility requirements for persons purchasing health insurance policies that pay for basic health care services from the company. At a minimum, to qualify for coverage under a health insurance policy issued by the company, a person seeking coverage shall not be eligible for coverage under any other group or group-type insurance plan subject to chapter 393, any federal or state operated health insurance plan, any retirement health insurance benefit plan offered through the person's employer, or any health insurance benefit plan offered by the employer of the person's spouse or reciprocal beneficiary."

SECTION 2. Section 431:14A-101, Hawaii Revised Statutes, is amended to read as follows:

"[[]§431:14A-101[]] Purpose. The Hawaii employers' mutual insurance company is established to provide [workers']:

at the highest level of service with the lowest possible cost, consistent with reasonable and applicable actuarial standards and the sound financial integrity of the company. The purposes of the company are to provide the highest standard of workplace safety and loss prevention, to encourage employer involvement, [and] to be responsive to each policyholder's experience, practice, and operating effectiveness[.], and to further the interest of the public by encouraging the principle of universal and affordable health insurance coverage."

SECTION 3. Section 431:14A-102, Hawaii Revised Statutes, is amended by adding a new definition to be appropriately inserted and to read as follows:

""Basic health care service" means the following medical services: preventative care, emergency care, inpatient and outpatient hospital and physician care, diagnostic laboratory services, and diagnostic and therapeutic and radiological services. It does not include mental health services, services for alcohol or drug abuse, dental or vision services, or long-term rehabilitation treatment, except as provided in chapter 431M."

SECTION 4. Section 431:14A-103, Hawaii Revised Statutes, is amended by amending subsections (a) and (b) to read as follows:

"(a) The Hawaii employers' mutual insurance company is established as an independent corporation to provide workers' compensation insurance and related services to Hawaii employers[.] and basic health care service insurance to qualified consumers in the State. The company may be reorganized as a nonprofit corporation under chapter 415B.

(b) The company shall be organized and operated as a domestic mutual insurance company. The company shall comply with, unless specifically excluded, all requirements of the insurance code regarding a domestic mutual insurance company. The company shall not be an agency of the State. The company or its liabilities shall not be deemed to constitute debts or liabilities of the State of Hawaii or pledges of the full faith and credit of the State. The company shall write workers' compensation insurance policies covering Hawaii employers as required or authorized by law and employers' liability to the same extent as any other private insurer. The company shall also write basic health care service insurance policies covering a consumer who is not otherwise able to obtain group or group-type health insurance coverage; provided that the consumer meets the eligibility requirements set forth in section 431:14A-  . The company shall not write other lines of insurance, reinsurance, or excess insurance."

SECTION 5. Section 431:14A-107, Hawaii Revised Statutes, is amended by amending subsection (c) to read as follows:

SECTION 6. Section 431:14A-110, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows:

"(a) The board shall establish the premium rates to be charged for insurance sold by the company. [The] With regard to workers' compensation insurance premium rates, the company shall comply with the requirements set forth in article 14 of this chapter. With regard to basic health care service insurance premium rates, the company shall comply with the requirements set forth in article 10A of this chapter. Premium rates shall be set at levels sufficient, when invested, to carry all claims to maturity, to meet the reasonable expenses for administering the company, and to maintain a reasonable surplus."

SECTION 7. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 8. This Act shall take effect upon its approval.