Hawaii Revised Statutes 431:14G-109 – Information to be furnished enrollees; hearings and appeals of enrollees
Terms Used In Hawaii Revised Statutes 431:14G-109
- Enrollee: means a person who enters into a contractual relationship or who is provided with health care services or benefits through a managed care plan. See Hawaii Revised Statutes 431:14G-102
- plan: means a health plan as defined in section 431:10A, or chapter 432 or 432D, regardless of form, offered or administered by a health care insurer, including but not limited to a mutual benefit society or health maintenance organization, or voluntary employee beneficiary associations, but shall not include disability insurers licensed under chapter 431. See Hawaii Revised Statutes 431:14G-102
- Rate: means every rate, charge, classification, schedule, practice, or rule. See Hawaii Revised Statutes 431:14G-102
- Supplementary rating information: includes any manual or plan of rates, classification, rating schedule, minimum premium, policy fee, rating rule, underwriting rule, statistical plan, and any other similar information needed to determine the applicable rates in effect or to be in effect. See Hawaii Revised Statutes 431:14G-102
- Supporting information: means :
(1) The experience and judgment of the filer and the experience or data of other organizations relied on by the filer;
(2) The interpretation of any other data relied upon by the filer; and
(3) Descriptions of methods used in making the rates and any other information required by the commissioner to be filed. See Hawaii Revised Statutes 431:14G-102
Every managed care plan that makes its own rates, within a reasonable time after receiving written request therefore and upon payment of reasonable charges as it may make, shall furnish to any enrollee affected by a rate made by it or to the authorized representative of the enrollee, all pertinent information as to the rate; provided that the managed care plan shall not be required to disclose supporting information and supplementary rating information protected pursuant to section 431:14G-105(d).