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Hawaii Health Insurance

Hawaii Medical Insurance Overview

There are several options that exist in Hawaii for obtaining health insurance and among those are group coverage, individual policies and state-funded insurance.  Hawaii is the best state in the country in general when it comes to the overall health of its residents.  It is also the state with the lowest percentage of uninsured residents among those in the entire country.  With the implementation of healthcare reform, Hawaii is expected to see a rise in its insured population, but there is still some room for improvement.

Hawaii’s Health Care Issues
The United Health Foundation has ranked in the top position when compared to the overall health of the people living in the United States as a whole.  The state’s strengths are its low percentage of those suffering from obesity, low rate of hospitalizations that are preventable and the amount of mental health days that citizens have.  Weaknesses for the state include its problems with excessive drinking, its prevalence of Salmonella and the low rate of adolescents who have been immunized against TDAP.

Understanding Hawaii’s Uninsured Population
The uninsured population of the state of Hawaii is comprised of 5 percent of its total amount of residents.  For those who lack insurance coverage, the percentage is especially high for people between the ages of 15 and 44.  Between 1998 and 2007, the young population without insurance coverage has increased along with the percentage of uninsured individuals who were hospitalized.

Despite the good qualities of the health of the state’s citizens, 5 percent of the people living in Hawaii have no health insurance.   This percentage is close to the overall amount of Americans who are uninsured.
Below, you can see more information regarding Hawaii’s percentage of uninsured residents:

  • 3% of kids in Hawaii don’t have health insurance.
  • 25% of uninsured adults are poor in Hawaii and earn under the Federal Poverty Level.
  • 12% percent of adults in Hawaii who earn between 139 and 250% of the FPL have no insurance coverage.
  • Nearly 84% of companies operating in Hawaii offer health insurance under a group plan.

Group Health Plans
Group coverage is typically offered by your employer when you are hired on to work for the company.  What you should first learn is when the open enrollment period is so that you can apply for benefits.  Group plans are the most beneficial to workers because of the coverage options and costs.  Research all of the levels of coverage offered in order to make an informed decision about your future medical needs.  Private insurance companies in the state of Hawaii are governed by the Department of Commerce & Consumer Affairs, so you may want to look through their website’s information to learn your rights under a group plan.

Signing Up
Most companies have a period of time of which you can use to sign up for insurance benefits.  This is referred to as an open enrollment period and you should consult your HR rep to find out when this period is for your company.  Before signing up for insurance benefits, think about how the following affects your coverage options:

  • What does your group plan offer?  What does it exclude?
  • Are there any waiting or exclusionary periods that you will have to deal with?
  • What levels of coverage are available and at what cost?   Will you be able to afford insurance through your workplace?

Pre-Existing Condition Exclusion Periods
For those who have pre-existing conditions, HIPAA prevents insurance companies who offer group health plans from denying insurance coverage.  You will also not be subjected to exclusion periods in this case.
Affiliation or Waiting Periods
After beginning the enrollment process, you can be subjected to a waiting period of up to two months.  This period will be up to three months if you enroll into the plan late.

Individual Health Plans
If you can’t get insurance coverage through the workplace or union and aren’t eligible for state-funded programs, you may have to rely on an individual policy for health benefits.  Unfortunately, for those seeking this sort of insurance policy, if you have a pre-existing condition, you may have to wait up to 36 months for your benefits to be used.  There is also no limit on the look back period imposed on people living in the state.

Insurance companies use look back periods to dig through your medical history so they can find out if you have any sort of pre-existing medical conditions.  Individual policies are subject to a lot of underwriting on the part of the insurance company, so these types of plans are not always cost-effective.
It is believed that a healthy young person in Hawaii can obtain an individual insurance policy for around $75 per month.

Continuation Coverage
COBRA coverage is available to people who have temporarily lost their insurance coverage due to a job change or divorce from a covered spouse.  Eligibility depends on the size of the company that originally offered the coverage, but the plan can cover you for up to 18 months, if needed.

Hawaii Health Benefit Exchange
The health benefits exchange in Hawaii is called the Hawaii Health Connector and it meets the requirements under the Affordable Care Act for the creation and implementation of a health benefits marketplace.  In addition to a $1 million federal grant, Hawaii received additional grants to establish their online marketplace.
The website has been active since its implementation and provides a myriad of options for health insurance coverage for residents in the state of Hawaii.

Hawaii State-Funded Insurance Programs
State-funded health programs offer coverage options to 42% of residents living in the state of Hawaii.  To be eligible for coverage under the various programs available, you have to earn a certain amount of money, be of a certain sex, meet age requirements or have pre-existing health conditions.

Pre-Existing Condition Insurance Plan (PCIP)
Eligibility for PCIP depends on whether or not you are suffering from a pre-existing health condition.  If you have such a condition and have been without insurance benefits for at least six months, you may be granted coverage under this program.  To qualify, you must show proof of an insurance denial because of your condition, but there are a lot of coverage benefits available to qualified individuals.  Monthly premiums can cost between $116 and $500 for coverage under PCIP.

QUEST and QUEST Expanded
QUEST offers in-patient, outpatient and clinical services, along with nursing care and home health services and is available to only those who qualify based on income.  Limited prescription medication coverage is offered along with preventive and restorative dental care and substance abuse treatments under the QUEST Expanded program.  Premiums can cost between $0 and $60 per month for this benefits option.

Hawaii’s Medical Service Association (HMSA) Children’s Plan
Uninsured children living in Hawaii can be covered under HMSA as long as the covered child is ineligible for coverage through any other program.  Premiums cost $73 on a monthly basis for coverage under HMSA.

Breast & Cervical Cancer Control Program
Under the BCCCP, women can receive mammograms, breast exams, pap tests and pelvic exams.  Women who earn less than 250% of the Federal Poverty Level can be guaranteed benefits under this program.

Department of Health, Alcohol & Drug Abuse Division
People dealing with substance abuse can use this program in order to obtain treatment for their addiction issues.  There are detoxification programs, residential treatment options and more for those who qualify.  Preference is given to pregnant women and abusers of injectable drugs over all others when enrolling into the program.

Medicare, the Medicare Prescription Drug Program, and Sage Plus
Medicare is offered to seniors, the disabled and people suffering from renal disease.  For those over 65 years of age who have worked in a job that was covered by Medicare for over 10 years can receive various benefits through Medicare’s four part system.  For a breakdown of what is offered, those who qualify can receive counseling using the Sage Plus program in Hawaii.

VA Medical Benefits Package
The VA Medical Benefits program offers veterans of any military branch the ability to receive insurance benefits.  As long as the active duty requirement is met or the vet has served 24 consecutive months of service with the receipt of an honorable discharge, benefits are guaranteed.

STD/AIDS Prevention Branch
This program covers treatment and prevention in cases of STDs and AIDS infections through educational programs in the state of Hawaii.

WIC is a state-funded program that offers lower income women with information, resources and healthy food options for herself (if pregnant), her infant child or any children under the age of five-years-old.

The NAMI Helpline is a national program that is staffed by a team of volunteers who have a lot of knowledge on the resources and treatment options available to mental illness suffers.

HIPAA was enacted to offer strict rules on how your medical information could be treated in various health settings.  Now, with the implementation of the Affordable Care Act, HIPAA has also moved to offer regulations to insurance companies.

Among the regulated provisions are how far back insurance companies can look into your medical history, affiliation periods, how pre-existing conditions are treated, monthly premium costs and more.
For a wider scope of the benefits offered under HIPAA, read this website.