The islands of Hawaii are home to volcanoes, large waves, beaches, and many varieties of indigenous wildlife and plant life. Known for being a frequent tourist destination and surf spot, Hawaii is also a huge center for food production, including coffee and macadamia nuts. Residents of Hawaii live in their own time zone, and their capital, Honolulu, has the longest borders of any city in the world (including all islands in the Hawaiian Archipelago). Health insurance in Hawaii is mostly provided by employers, as the state law requires all employers to offer a group plan to their workers. For those seeking individual health insurance, Hawaiians have access to plans from Blue Cross Blue Shield of Hawaii, also known as the Hawaii Medical Service Association, and Kaiser Permanente. To get a quote for your area and specific criteria, enter your zip code in the quote engine below.

 


 

Health Status

As one could imagine because of the lack of air pollution, many opportunities to be active and access to healthy, locally grown foods, Hawaii is one of the most healthy states in the U.S.. Ranked #4 by the UnitedHealth Foundation in 2011, Hawaii moved up one place by increasing its overall health. Some supporting evidence as to Hawaii’s outstanding level of health compared to the rest of the country is the low frequency of uninsured individuals, decreased number of smokers, and the highest amount of public health funding per capita in the nation. There is also a lower population of obese individuals, as it affects 23% of adults, and a low rate of preventable hospitalization.

Hawaii residents have experienced some increases in unhealthy characteristics, including diabetes among adults, which has increased in the past five years to 8% of the population. Binge drinking is also an issue among Hawaiians, affecting 17.5% of adults. Despite these negatives, the state is mostly a very healthy place to live. If all Hawaiians continue to get proper nutrition and exercise, limit alcohol consumption to below an excessive level, and seek medical care when needed, Hawaii will remain one of the most healthy states for years to come.

 

Health Insurance Plans

 

HMSA Blue Cross Blue Shield of Hawaii

  • Individual Care plans offer two HMO options, Basic and High, and give you access to over 1,800 health care providers. Deductibles for Basic plans are $500 for individuals and $1,500 for families, and High plans have a $300 deductible for individuals and $1,500 for families. These plans require you to choose a primary care doctor and a health center to coordinate your care. Before you meet the deductible, there are several services available for a copayment, such as doctor’s office visits for $20. Preventive care is available from the day your plan starts and is covered in full for routine physicals, well child care, immunizations and more.
  • Catastrophic Care plans have a higher annual deductible with lower monthly premiums for a comprehensive set of benefits. These plans allow you to use preventive services as soon as your plan begins for no cost, including screenings for various diseases and cancers, annual health exams, vaccinations, women’s health care and more. Catastrophic Care Plans cover major medical care at 100% such as hospitalization, surgery and emergency room visits, after you meet the deductible. These plans also qualify for use with a health savings account, so you can use tax-advantaged funds to pay for health care services, or save for the future.

 

Kaiser Permanente

  • Copay plans from Kaiser Permanente in Hawaii are available in three types: 20/Rx, 30/Rx and Basic. There is also a separate Copay plan for Children. These plans offer a variety of services as soon as your plan starts for a predictable copayment, which includes doctor’s office visits, emergency care, prescription drugs through a retail or mail order pharmacy, outpatient surgery and inpatient care. Preventive services are also immediately accessible through the KP HMO network for no cost. Basic plans do not have coverage on physician services, outpatient care (except surgery in a hospital) or prescription drugs. These plans are convenient and offer an easy way to pay for medical care.

 

 

Public Health Options

The state of Hawaii offers several programs for those who have a low income, and therefore cannot afford health insurance. The primary health insurance alternative funded by the state is Med-QUEST, or Medicaid, which is available to Hawaii residents who are uninsured, families and children who meet certain criteria, and other individuals such as pregnant women, Hawaiians over age 65, and persons who are blind or disabled. There are also other groups who are accepted for the QUEST program, for a more detailed outline of qualifying factors, visit out Medicaid Eligibility by State page. Most services will be administered by the Hawaii Department of Human Services, though Medicaid is run by the federal government as well through the Centers for Medicare & Medicaid Services (CMS). Below is a list of several important programs to know about if you are uninsured in Hawaii.

  • Med-QUEST: medical coverage for uninsured or uninsurable residents of Hawaii with medical and financial needs.
  • Hawai’i Covering Kids: Hawaii’s Children’s Health Insurance Program (CHIP) for low-income residents under age 19, offering free health care through Med-QUEST.
  • Women, Infants & Children (WIC) Program: nutritional assistance for pregnant and breastfeeding women, and new mothers with limited means to encourage healthy living.
  • Hawaii Aids Drug Assistance Program: for residents of Hawaii with HIV/AIDS who need assistance affording medications to help elongate their lifespan.

 

Health Insurance Laws

In Hawaii, one of the most important health insurance regulations is the guaranteed issue of health plans through an employer. Because all Hawaiian employers are required to provide their employees with a group policy, this makes the private health insurance market much smaller. There are still individuals who are not working or are sole proprietors, or have other life circumstances that make this rule obsolete and therefore need a private health plan. When looking for insurance with one of your two insurance company choices, there are certain laws they abide by that keep the insurer safe, and some that keep the policy-holder safe.

When you apply for a plan, the underwriter will decide if you have a pre-existing condition based on the insurance company’s judgment of what qualifies. There is no definition of  pre-existing condition to follow in Hawaii, which leaves things quite open-ended. These afflictions can range from acne to cancer, as long as you have had any trace of a medical condition in need of treatment. Once you have been determined as having a pre-existing condition, the insurance company has the right to deny you a plan, or accept you for a plan with increased premiums and a few other bells and whistles.

Insurance companies in Hawaii are allowed to attach an elimination rider to your plan, which states that they will never pay for any care related to that condition as long as you are insured by them. They can also issue an exclusion period, which means they will not cover the treatment of that condition for a certain amount of time. There is a 36 month limit on exclusion periods in Hawaii. For those who do have a pre-existing condition and want to have a more equal set of benefits for an affordable rate, there is the Pre-Existing Condition Insurance Plan. In Hawaii, PCIP is run by the U.S. Department of Health and Human Services, and they offer plans with relatively low premiums so people with conditions can afford health care.

Under the Affordable Care Act, the first day of 2014 will bring a new equality to adults with pre-existing conditions. Once that date has arrived, PCIP plans will no longer be available and all adults must be accepted by private insurers and state health exchanges for coverage at the same rate as a person of a normal health standing. Elimination riders and exclusion periods will also be discontinued, and illegal to use after that point. To promote the use of health insurance, this new law will bring many more Hawaiians access to more health care services, and help improve the quality of life.

Guaranteed renewability is an important law for Hawaiians who have any kind of health insurance. This regulation prevents health insurers from terminating your benefits simply because you have acquired an illness or condition after you signed up for your plan. If you are paying your necessary fees and not violating your plan in any way, you are allowed to keep your coverage. This laws also makes sure that the insurance company you are with asks to renew your same plan at the end of a term. Guaranteed renewal is part of of HIPAA, which ensures protection of individuals receiving health care services.