Report Title:
Health Insurance; Choice of Provider
Description:
Allows a person entitled to benefits to choose a traditional, alternative, complementary or integrative health care provider; provided that the provider is licensed by the State; further provided that the health care service is within the provider's lawful scope of practice.
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THE SENATE |
S.B. NO. |
1418 |
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TWENTY-THIRD LEGISLATURE, 2005 |
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STATE OF HAWAII |
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A BILL FOR AN ACT
relating to health insurance.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
SECTION 1. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 10A to be appropriately designated and to read as follows:
"§431:10A- Policy coverage. (a) It is the intent of the legislature to recognize traditional, alternative, complementary, and integrative health care services or care as reimbursable services for which a person entitled to benefits may receive reimbursement for health care services or care.
(b) All individual and group accident and health or sickness insurance policies issued in this State and individual or group hospital or medical service plan contracts shall permit every category of health care provider to provide health services or care for conditions that are included in the basic health plan services; provided that:
(1) The provision of the health services or care is within the health care provider's lawful scope of practice; and
(2) The health care provider abides by standards related to:
(A) Provision, utilization review, and cost containment of health services or care;
(B) Management and administrative procedures; and
(C) Provision of cost-effective and clinically efficacious health services or care.
(c) Notwithstanding any provision to the contrary, whenever a policy, contract, plan, or agreement provides for reimbursement for any health care service, which is within the lawful scope of practice of a duly licensed health care provider, the person entitled to benefits or the person performing the service shall be entitled to reimbursement whether the service is performed by a traditional, alternative, complementary, or integrative health care provider.
(d) An insurer may require a health care provider to abide by standards promulgated by the insurer; provided that the standards shall not unreasonably exclude categories of health care providers.
(e) An insurer may place reasonable limits on the health care services rendered by specific categories of health care providers; provided that the insurer shall not limit the type of health care provider who may render the service.
(f) An insurer offering a policy, contract, plan, or agreement with a restricted network may select the individual health care providers in any category of health care providers with whom the insurer will contract or provide reimbursement.
(g) An insurer shall not offer coverage for health care services for certain categories of health care providers as a separately priced optional benefit."
SECTION 2. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to article 1 to be appropriately designated and to read as follows:
"§432:1- Policy coverage. (a) It is the intent of the legislature to recognize traditional, alternative, complementary, and integrative health care services or care as reimbursable services for which a person entitled to benefits may receive reimbursement for health care services or care.
(b) All individual and group accident and health or sickness insurance policies issued in this State by a nonprofit mutual benefit society shall permit every category of health care provider to provide health services or care for conditions that are included in the basic health plan services; provided that:
(1) The provision of the health services or care is within the health care provider's lawful scope of practice; and
(2) The health care provider abides by standards related to:
(A) Provision, utilization review, and cost containment of health services or care;
(B) Management and administrative procedures; and
(C) Provision of cost-effective and clinically efficacious health services or care.
(c) Notwithstanding any provision to the contrary, whenever a policy, contract, plan, or agreement provides for reimbursement for any health care service, which is within the lawful scope of practice of a duly licensed health care provider, the person entitled to benefits or the person performing the service shall be entitled to reimbursement whether the service is performed by a traditional, alternative, complementary, or integrative health care provider.
(d) An insurer may require a health care provider to abide by standards promulgated by the insurer; provided that the standards shall not unreasonably exclude categories of health care providers.
(e) An insurer may place reasonable limits on the health care services rendered by specific categories of health care providers; provided that the insurer shall not limit the type of health care provider who may render the service.
(f) An insurer offering a policy, contract, plan, or agreement with a restricted network may select the individual health care providers in any category of health care providers with whom the insurer will contract or provide reimbursement.
(g) An insurer shall not offer coverage for health care services for certain categories of health care providers as a separately priced optional benefit."
SECTION 3. Chapter 432D, Hawaii Revised Statutes, is amended by adding a new section to be appropriately designated and to read as follows:
"§432D- Policy coverage. (a) It is the intent of the legislature to recognize traditional, alternative, complementary, and integrative health care services or care as reimbursable services for which a person entitled to benefits may receive reimbursement for health care services or care.
(b) All individual and group accident and health or sickness insurance policies issued in this State by a health maintenance organization plan shall permit every category of health care provider to provide health services or care for conditions that are included in the basic health plan services; provided that:
(1) The provision of the health services or care is within the health care provider's lawful scope of practice; and
(2) The health care provider abides by standards related to:
(A) Provision, utilization review, and cost containment of health services or care;
(B) Management and administrative procedures; and
(C) Provision of cost-effective and clinically efficacious health services or care.
(c) Notwithstanding any provision to the contrary, whenever a policy, contract, plan, or agreement provides for reimbursement for any health care service, which is within the lawful scope of practice of a duly licensed health care provider, the person entitled to benefits or the person performing the service shall be entitled to reimbursement whether the service is performed by a traditional, alternative, complementary, or integrative health care provider.
(d) An insurer may require a health care provider to abide by standards promulgated by the insurer; provided that the standards shall not unreasonably exclude categories of health care providers.
(e) An insurer may place reasonable limits on the health care services rendered by specific categories of health care providers; provided that the insurer shall not limit the type of health care provider who may render the service.
(f) An insurer offering a policy, contract, plan, or agreement with a restricted network may select the individual health care providers in any category of health care providers with whom the insurer will contract or provide reimbursement.
(g) An insurer shall not offer coverage for health care services for certain categories of health care providers as a separately priced optional benefit."
SECTION 4. Section 431:10A-207, Hawaii Revised Statutes, is amended to read as follows:
"§431:10A-207 Coverage for specific services. Every person insured under a group or blanket disability insurance policy shall be entitled to the reimbursements and coverages specified in [section] sections 431:10A-116[.] and 431:10A- ."
SECTION 5. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.
SECTION 6. This Act shall take effect upon its approval.
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INTRODUCED BY: |
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