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. Medical underwriting is allowed without restriction in Hawaii. Medical underwriting is the process that allows insurance companies the right to review the health history of prospective members. 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 individual health insurance:
- Private health insurance
- Health insurance through an association
- Health insurance through income eligibility program
There is currently no high risk pool for those individuals without insurance and who are uninsurable.
Since 1974, Hawaii has required all employers to provide employees with health insurance coverage under qualified prepaid group health plans. As a result, a greater portion of residents in Hawaii have health insurance coverage than in any other state in the U.S. In Hawaii, medical underwriting is allowed with reasonable rate restrictions that are approved by the state Department of Insurance. For preexisting condition requirements, the carrier may look back in a consumer's medical history 6 months and impose a 12 month exclusionary period for those that did not have prior medical coverage.
To visit small group plans in Hawaii, visit our Hawaii Small Group page.
Hawaii offers COBRA (Consolidate Omnibus Budget Reconciliation Act of 1985). Many companies with 20 or more employees that offer health insurance are required to offer employees and their dependents continuation coverage for benefits that were lost due, for example, to job loss, reduction in hours worked, death, or divorce.
If you cannot afford private insurance or insurance through associations, you may be eligible for government subsidized programs that has been designed to keep individuals in Hawaii health an insured. The Med-Quest Division is responsible for the overall administration for the Medicaid Program in the state of Hawaii. See below for eligibility requirements:
Pregnant Women and Infants
- Ages 1-5: 200% of the Federal Poverty Level
- Ages 6-19: 200% of the Federal Poverty Level
- Pregnant Women: 185% of the Federal Poverty Level
- Infants Ages 0-1: 200% of the Federal Poverty Level
- Non-Working: 100% of the Federal Poverty Level
- Working: 100% of the Federal Poverty Level
Medically Needy Individual- 51% of the Federal Poverty Level Medically Needy Couple- 51% of the Federal Poverty Level
Aged, blind, and disabled- 100% of the Federal Poverty Level
Inpatient hospital services, outpatient hospital services, prenatal care, vaccines for children, physician services, nursing facility services for persons aged 21 or older, family planning services and supplies, rural health clinic services, home health care for persons eligible for skilled-nursing services, laboratory and x-ray services, pediatric and family nurse practitioner services, nurse-midwife services, Federally Qualified Health-Center services, and ambulatory services of an FQHC that would be available in other settings, early and periodic screening, diagnostic, and treatment services for children under age 21.
Co-pays vary. There are no co-payments if you are under 18, pregnant, living in a nursing home, or receiving family planning services.
You may learn more about Hawaii Medicaid here.
Click here to learn about Hawaii Medicare plans.
Hawaii offers a program called Quest to children under age 19 with family incomes of up to 200% of the Federal Poverty Level. The children must be either U.S. citizens or legal residents, residents of Hawaii, have a Social Security number, not be in an institution, and not be blind or disabled. The program is also available to adults under the age of 65 who is a U.S. citizen or legal resident, resident of Hawaii, has a Social Security number, are not a resident of an institution, are not blind or disabled and are not able to receive health insurance through an employer. Please visit the quest website for more detailed information at http://www.med-quest.us/eligibility/