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HB1536
HOUSE OF REPRESENTATIVES
H.B. NO.
1536
THIRTY-THIRD LEGISLATURE, 2026
STATE OF HAWAII
A BILL FOR AN ACT
relating
to health insurance
.
BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII:
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SECTION 1.
�
Chapter 431, Hawaii Revised Statutes, is
amended by adding a new section to article 10A to be appropriately designated
and to read as follows:
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"
�431:10A-
�
Prosthetic devices and orthotic devices; benefits and coverage.
�
(a)
�
Each individual or group
policy of accident and health or sickness insurance issued or renewed in the
State on or after January 1, 2027, shall provide coverage for the cost of a
prosthetic device or orthotic device for the policyholder or any dependent of
the policyholder who is covered by the policy.
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(b)
�
Prosthetic device purchases covered under
this section shall be subject to a minimum benefit of
$ per affected limb
every year.
�
Orthotic device purchases
covered under this section shall be subject to a minimum benefit of
$ every year.
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(c)
�
The policyholder or individual covered under
the policy may choose a prosthetic device or orthotic device that is priced
higher than the benefit payable under this section without financial or
contractual penalty to the provider of the prosthetic device or orthotic device.
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(d)
�
This section shall not prohibit an insurer from
providing coverage that is greater or more favorable to the policyholder and
individuals covered under the policy.
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(e)
�
Coverage required under this section may be
subject to deductibles, copayments, coinsurance, or annual or maximum payment
limits that are consistent with deductibles, copayments, coinsurance, and
annual or maximum payment limits applicable to other similar coverage under the
policy.
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(f)
�
Annual information that is made available to
policyholders shall include information concerning the coverage required by
this section.
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(g)
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This section shall not apply to limited
benefit health insurance as provided in section 431:10A-607.
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(h)
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For the purposes of this section:
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"Orthotic
device" means a custom fabricated or fitted medical device used to
support, correct, or alleviate neuromuscular or musculoskeletal dysfunction,
disease, injury, or deformity.
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"Prosthetic
device" means any artificial device or appliance, instrument, apparatus,
or contrivance, including their components, parts, accessories, and
replacements thereof, used to replace a missing or surgically removed part of
the human body, that is prescribed and sold by a physician or osteopathic
physician licensed under chapter 453 or podiatrist licensed under chapter 463E or
that is dispensed and sold by a dealer of prosthetic or orthotic devices.
�
"Prosthetic device" includes an
activity-specific device that is designed for an activity that could damage a
residual limb or everyday prosthesis, or to replace an everyday prosthesis that
would not function effectively when performing a specific activity.
�
"Prosthetic device" does not
include any auditory, ophthalmic, dental, or ocular device or appliance,
instrument, apparatus, or contrivance.
"
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SECTION 2.
�
Chapter 432, Hawaii Revised Statutes, is
amended by adding a new section to article 1 be appropriately designated and to
read as follows:
����
"
�432:1-
�
Prosthetic devices and orthotic devices; benefits and coverage.
�
(a)
�
Each
individual
or group hospital or medical service plan contract
issued or renewed in the State on or after
January 1, 2027, shall provide coverage for the cost of a prosthetic device or
orthotic device for the subscriber or member or any dependent of the subscriber
or member who is covered by the plan contract.
����
(b)
�
Prosthetic device purchases covered under
this section shall be subject to a minimum benefit of
$ per affected limb
every year.
�
Orthotic device purchases
covered under this section shall be subject to a minimum benefit of
$ every year.
����
(c)
�
The subscriber or member or any dependent of
the subscriber or member covered under the plan contract may choose a prosthetic
device or orthotic device that is priced higher than the benefit payable under
this section without financial or contractual penalty to the provider of the prosthetic
or orthotic device.
����
(d)
�
This section shall not prohibit a mutual
benefit society from providing coverage that is greater or more favorable to
the subscriber or member and any dependent of the subscriber or member covered
under the plan contract.
����
(e)
�
Coverage required under this section may be
subject to deductibles, copayments, coinsurance, or annual or maximum payment
limits that are consistent with deductibles, copayments, coinsurance, and
annual or maximum payment limits applicable to other similar coverage under the
plan contract.
����
(f)
�
Annual information that is made available to subscribers
and members shall include information concerning the coverage required by this
section.
����
(g)
�
For the purposes of this section:
����
"Orthotic
device" means a custom fabricated or fitted medical device used to
support, correct, or alleviate neuromuscular or musculoskeletal dysfunction,
disease, injury, or deformity.
����
"Prosthetic
device" means any artificial device or appliance, instrument, apparatus,
or contrivance, including their components, parts, accessories, and
replacements thereof, used to replace a missing or surgically removed part of
the human body, that is prescribed and sold by a physician or osteopathic
physician licensed under chapter 453 or podiatrist licensed under chapter 463E
or that is dispensed and sold by a dealer of prosthetic or orthotic devices.
�
"Prosthetic device" includes an
activity-specific device that is designed for an activity that could damage a
residual limb or everyday prosthesis, or to replace an everyday prosthesis that
would not function effectively when performing a specific activity.
�
"Prosthetic device" does not
include any auditory, ophthalmic, dental, or ocular device or appliance,
instrument, apparatus, or contrivance.
"
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SECTION
3
.
�
Section
432D-23, Hawaii Revised Statutes, is amended to read as follows:
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"
�432D-23
�
Required provisions and
benefits.
�
Notwithstanding any
provision of law to the contrary, each policy, contract, plan, or agreement
issued in the State after January 1, 1995, by health maintenance organizations
pursuant to this chapter, shall include benefits provided in sections
431:10-212, 431:10A-115, 431:10A-115.5, 431:10A-116, 431:10A-116.2,
431:10A-116.5, 431:10A-116.6, 431:10A-119, 431:10A-120, 431:10A-121,
431:10A-122, 431:10A-125, 431:10A-126, 431:10A-132, 431:10A-133,
431:10A-134,
431:10A-140, and [
431:10A-134,
] and
431:10A- ,
chapter 431M."
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SECTION 4.
�
The benefits and coverage to be provided by
health maintenance organizations corresponding to the benefits and coverage provided
under section 431:10A- , Hawaii Revised Statutes, as contained
in the amendment to section 432D-23, Hawaii Revised Statutes, in section 3 of
this Act, shall take effect for all policies, contracts, plans, or agreements
issued or renewed in the State on or after January 1, 2027.
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SECTION 5.
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Statutory material to be repealed is
bracketed and stricken.
�
New statutory
material is underscored.
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SECTION 6.
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This Act shall take effect upon its approval.
INTRODUCED BY:
_____________________________
Report Title:
Health
Insurance; Mandatory Coverage; Health Benefits; Prosthetic Devices; Orthotic
Devices; Health Insurers; Mutual Benefit Societies; Health Maintenance
Organizations
Description:
Requires
insurers, mutual benefit societies, and health maintenance organizations to
provide coverage for the cost of prosthetic devices, including activity-specific
prostheses, and orthotic devices for policies, contracts, plans, and agreements
issued or renewed on or after 1/1/2027.
�
Establishes an unspecified minimum yearly benefit for prosthetic devices
and orthotic devices.
The summary description
of legislation appearing on this page is for informational purposes only and is
not legislation or evidence of legislative intent.