Hello,
I am responding to your question regarding health insurance in Hawaii.
I live in Hawaii and have often held part-time or independent
contractor positions and have researched exclusions for relatives so I
am familiar with Hawaii health insurance options. I have included
resources for both your short and longer term planning. These include
COBRA, Hawaii employer health insurance laws, student health
insurance, and private health insurance plans. For your immediate
coverage and the coming year, if someone has employer health insurance
the COBRA law allows this to be continued for 18-36 months. An
important factor in whether or not your pre-existing condition matters
is if you are HIPAA eligible. HIPAA imposes limits on the extent to
which some group health plans can exclude coverage for pre-existing
conditions. For instance, if you've had "creditable" health insurance
for 12 straight months, with no lapse in coverage of 63 days or more,
a new group health plan cannot invoke the pre-existing condition
exclusion. It must cover your medical problems as soon as you enroll
in the plan.
For possibilities of insurance under a Hawaii employer, the law in
Hawaii states that if you are an employee working for an employer at
least 20 hours a week the employer is required to provide you
coverage. If either you or your wife sign up for two classes (6
credits) at a community college or at the University of Hawaii you
will be eligible for the UH health plan. This gives you a choice of
Kaiser or HMSA plans and family members can be included. There is no
health screening. Once a year's residency is established, tuition is
around $45 dollars a credit. HSAs (Health Savings Accounts) are
available in Hawai?i for sole proprietors, self-employed individuals,
and those working as part-time employees.
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First here is the continued coverage site for COBRA:
"How long does COBRA coverage last?
COBRA establishes required periods of coverage for continuation health
benefits. A plan, however, may provide longer periods of coverage
beyond those required by COBRA. COBRA beneficiaries generally are
eligible for group coverage during a maximum of 18 months for
qualifying events due to employment termination or reduction of hours
of work. Certain qualifying events, or a second qualifying event
during the initial period of coverage, may permit a beneficiary to
receive a maximum of 36 months of coverage."
http://www.dol.gov/ebsa/faqs/faq_consumer_cobra.html
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Here is another site in regards to COBRA:
http://www.cobrahealth.com/
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Here is a site that give you a summary of health insurance options in Hawaii.
"In Hawaii you are not guaranteed the right to buy health insurance,
except if you are federally eligible. In Hawaii, individual plans can
count any condition for which you received medical advice, diagnosis,
care, or treatment in the three years before individual coverage
begins as pre-existing. Elimination riders can be imposed.
Your health status can be used to determine the premium you pay. In
Hawaii, you have guaranteed renewability, which means that if you paid
all of the premiums you cannot be denied coverage even if you become
ill.
You have three basic options for obtaining health insurance as an
individual other than employer or union plans in Hawaii:
Private Health Insurance
Health Insurance through Associations
Health Insurance through Income Eligible Programs"
http://www.ahirc.org/quickguide_hawaii.html
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Hawaii Medical Library - Hawaii Health Care Plans
http://hml.org/CHIS/providers/planshawaii.html
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HMSA - Hawaii Medical Services Association - is the largest health
insurance organization in Hawaii and the coverage is excellent, as it
was initially founded to serve Hawaii's labor union members.
"Individual plans are designed for people who are not eligible for
coverage through employer group plans. Individual plans available
through HMSA include plans for students, senior citizens, individual
business owners and those who are unemployed."
See:
Individual Care Plan
For individuals who want a wide range of covered medical services.
Conversion Plan 10
For group members converting to individual coverage who...meet the
HIPAA eligibility requirements.
http://www.hmsa.com/healthplans/individual.asp
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University of Hawaii provides excellent HMSA group health plans for
students taking 6 credits or more, and family members can be added:
"The health insurance plan that is available to students enrolled in
the University of Hawai'i system offers coverage comparable to that of
other providers at a lower price. A health insurance plan from Hawai'i
Medical Service Association costs an average of $2,400 a year, while
the comprehensive UH student insurance plan offers similar coverage
for $1,607.76. The basic plan costs $1,117.56.
In order to be eligible for the UH health insurance plan, students
must be enrolled at least part-time. This means that undergraduate
students need to have a minimum of six credits and graduate students
need to have a minimum of four credits during the fall and spring
semesters; a minimum of three credits is required for the summer
semester. Students have the option of purchasing the university health
insurance plan on an annual or semester-by-semester basis.
Coverage is available for individual, two-party and family plans, with
varied membership dues for each plan."
http://www.emaxhealth.com/72/4490.html
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This site for Kaiser Permamente has a phone number for individual plan
price quotes:
"We understand that choosing a health plan isn't easy. That's why we
created health plans to fit the life you live. With Kaiser Permanente
for Individuals and Families*, you get affordable coverage and quality
health care you and your family can rely on.
*Kaiser Permanente for Individuals and Families was formerly known as
Personal Advantage.
Get an Instant Quote to find your rate.
For questions on individual plans call 1 800 207 5084
https://ehealthplan.kp.org/ApplyOnline/index.html
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A Consumer's Guide to Getting and Keeping Health Insurance in Hawaii
Georgetown University Health Policy Institute
October 2005
"This guide describes your protections as a Hawaii resident. Chapter 1
gives an overview of your protections. Chapters 2 and 3 explain your
protections under group and individual health plans. Chapter 4
highlights your protections as a small employer.
Chapter 5 summarizes help that may be available to you if you cannot
afford health coverage.
......
Contents
1. A summary of your protections ...........................................2
--How am I protected?.......................................................2
--What are the limits on my protections?....................................3
2. Your protections under group health plans................................5
--When does a group health plan have to let me in?..........................5
--Can a group health plan limit my coverage for pre-existing conditions?....7
--As you are leaving group coverage.........................................7
3. Your protections when buying individual health insurance.................8
--Individual health insurance sold by private insurers......................8
--COBRA continuation........................................................10
4. Your protections as a small employer or self-employed person.............15
--Do insurance companies have to sell me health insurance?..................15
--Can I be charged more because of my group?s health status?................15
--What plan choices do I have?..............................................15
--What if I am self-employed?...............................................16
--A word about association plans............................................16
5. Financial assistance.....................................................17
--Medicaid..................................................................17
--Hawaii Quest..............................................................19
--Hawaii Breast and Cervical Cancer Control Program.........................20
--Other programs............................................................21
--The Federal Health Coverage Tax Credit (HCTC).............................21
--For more information?.....................................................24
......
Chapter 3
Protections When Buying Individual Health Insurance
If you do not have access to employer-sponsored group insurance, you
may want to buy an individual health insurance policy from a private
health insurance company. However, in Hawaii ? as in most other states
? you have limited guaranteed access to individual health insurance.
There are some alternatives to individual health insurance ? such as
COBRA. This chapter summarizes your protections under different kinds
of health plan coverage.
In Hawaii, your ability to buy individual health insurance may depend
on your health status. There are certain circumstances, however, when
you must be allowed to buy individual health insurance.
? In general, companies that sell individual health insurance in
Hawaii are free to turn you down because of your health status and
other factors.
? If you are HIPAA eligible, private insurers cannot turn you down.
Companies that sell individual insurance must offer you a choice of at
least 2 plans that they sell.
To be HIPAA eligible, you must meet certain criteria.
If you are HIPAA eligible you are guaranteed the right to buy an
individual health policy and are exempted from pre-existing condition
exclusion periods. To be HIPAA eligible, you must meet all of the
following:
? You must have had 18 months of continuous creditable coverage, at
least the last day of which was under a group health plan.
? You also must have used up any COBRA or state continuation coverage
for which you were eligible.
? You must not be eligible for Medicare, Medicaid or a group health plan.
? You must not have health insurance. (Note, however, if you know your
group coverage is about to end, you can apply for coverage for which
you will be federally eligible.)
? You must apply for health insurance for which you are federally
eligible within 63 days of losing your prior coverage.
HIPAA eligibility ends when you enroll in an individual plan, because
the last day of your continuous health coverage must have been in a
group plan. You can become federally eligible again by maintaining
continuous coverage and rejoining a group health plan.
......
What About Coverage for My Pre-Existing Condition?
"A group health plan cannot impose pre-existing condition exclusion
periods. When you join a group health plan in Hawaii that plan must
immediately pay for all covered services, even those relating to a
condition (such as asthma or diabetes) you may have had prior to
joining the plan.
If are purchasing individual health insurance as a HIPAA eligible
individual no pre-existing condition exclusion periods or elimination
riders can be imposed on your individual health insurance policy."
http://www.healthinsuranceinfo.net/hi.pdf
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Here is another option called an HSA that should be available in the near future:
"What is a Health Savings Account (HSA)?
In January 2004, Congress authorized Health Savings Accounts (HSAs) as
a combination of a high-deductible health insurance plan and a
tax-advantaged savings account which can be spent on medical and
health expenses. With the high deductible health insurance, people
have the security of being insured for medical care in case of serious
illness or injury. With an HSA, people have the freedom to choose the
medical and healthcare services they want, and use tax-free money to
pay for it.
Are HSAs available in Hawai?i?
HSAs are available in Hawai?i for sole proprietors, self-employed
individuals, and those working as part-time employees. For Hawai?i
employers, the Hawai?i Prepaid Health Care Law requires that all
health insurance plans offered by Hawai?i employers must be approved
as a qualified plan by the state government?s Prepaid Health Care
Council. So, insurers must get state approval of their HSA product
before Hawai?i employers can offer HSAs to their employers. There are
a number of options available to Hawaii residents. Merrill Lynch is
rolling out a savings plan for HSAs and GSAA Benefits
Http://www.econsumersaver.com/ offers high deductible health insurance
with a tax-favored savings account. Money in the savings account helps
pay the deductible. Once the deductible is met, the insurance starts
paying. Money left in the savings account earns interest and is yours
to keep.
Next steps for HSAs in Hawai?i
For many Americans, HSAs started to be available in January 2004 when
Congress authorized them to be established.
However, in Hawai?i, it appears that HSAs will become a reality only
after some important steps are taken by state officials and insurers.
First, the state tax law needs to incorporate all the new changes
Congress just made to the federal tax law to establish HSAs.
Then insurance companies need to register any qualified high
deductible health insurance plans with the state insurance
commissioner with details on premiums and coverage."
http://www.fivemountains.org/msa.html
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I hope that you find this information useful. Please let me know if I
can be of further assistance. jdb-ga |
