(a) If the commissioner determines that:

Terms Used In Hawaii Revised Statutes 431:26-107

  • carrier: includes an accident and health or sickness insurer that issues health benefit plans under part I of article 10A of this chapter, a mutual benefit society under article 1 of chapter 432, and a health maintenance organization under chapter 432D. See Hawaii Revised Statutes 431:26-101
  • Commissioner: means the insurance commissioner of the State. See Hawaii Revised Statutes 431:26-101
  • Contract: A legal written agreement that becomes binding when signed.
  • Health care services: means services for the diagnosis, prevention, treatment, cure, or relief of a physical, mental, or behavioral health condition, illness, injury, or disease, including mental health and substance use disorders. See Hawaii Revised Statutes 431:26-101
  • Network: means the group or groups of participating providers providing services under a network plan. See Hawaii Revised Statutes 431:26-101
  • Network plan: means a health benefit plan that either requires a covered person to use, or creates incentives, including financial incentives, for a covered person to use, health care providers managed, owned, under contract with, or employed by the health carrier. See Hawaii Revised Statutes 431:26-101
  • provider: means a health care professional, pharmacy, or facility. See Hawaii Revised Statutes 431:26-101
(1) A health carrier has not contracted with a sufficient number of participating providers to ensure that covered persons have accessible health care services in a geographic area;
(2) A health carrier’s network access plan does not ensure reasonable access to covered benefits;
(3) A health carrier has entered into a contract that does not comply with this article; or
(4) A health carrier has not complied with this article, then the commissioner shall require a modification to the access plan, institute a corrective action plan that shall be followed by the health carrier, or use any of the commissioner’s other enforcement powers to obtain the health carrier’s compliance with this article.
(b) The commissioner shall not arbitrate, mediate, or settle disputes regarding a decision not to include a provider in a network plan or provider network or regarding any other dispute between a health carrier, its intermediaries, or one or more providers arising under a provider contract or its termination.

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