Health Insurance Marketplace in Hawaii
If you live in Hawaii, the Hawaii Health Connector is the Health Insurance Marketplace to serve you. Instead of HealthCare.gov, you’ll use the Hawaii Health Connector website to apply for coverage, compare plans, and enroll. Visit Hawaii Health Connector now to learn more.
Choosing the Right Health Insurance Plan
There are a number of different tiers of plans available on the Hawaii Health Insurance Exchange. Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:
NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.
Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.
Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.
Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.
Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.
Hawaii health insurers don’t have to offer every tier of plan, but within the Hawaii health insurance exchange, all health insurance companies must offer at least one silver plan and one gold plan to consumers.
Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.
Hawaii will expand its Medicaid program in 2014 to cover households with incomes up to 133% of the federal poverty level. That works out to about $18,200 a year for 1 person or $37,300 for a family of 4. You can find out whether you qualify for Medicaid in Hawaii 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.
If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know with the form below and we’ll get right back to you.
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Accountable Care Organizations in Hawaii
ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.
- University Of Arkansas For Medical Sciences HI – Health Care Innovation Award
- Firstvitals Health And Wellness, Inc. HI – Health Care Innovation Award
- University Of Hawaii At Hilo H – Health Care Innovation Award
- St. Francis Healthcare Foundation Of Hawaii HI – Health Care Innovation Award
- State of Hawaii – Incentives for the Prevention of Chronic Diseases in Medicaid Demonstration
- State of Hawaii – State Innovation Models Initiative: Model Design Award
Health care facilities where Innovation Models are being tested
- Bay Clinic Inc., Hilo Family Health Center Hilo, HI- Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Bay Clinic Inc., Kea’au Family Health Center Keaau, HI – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Bay Clinic Inc., Pahoa Family Health Center Pahoa, HIA – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- West Hawaii Community Health Center Kailua Kona, HI – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Thomas Tsang MD, MPH, FACPM Honolulu, HI – Innovation Advisors Program
- Maui County Office on Aging Wailuku, HI – Community-based Care Transition Program
The Insurance Exchange/Marketplace
What has been done, not been done, or left up to the federal government to do.
Establishing the Exchange in Hawaii
On July 11, 2011, Governor Neil Abercrombie (D) signed SB 1348 into law establishing the Hawaii Health Connector,a state-based health insurance exchange.1 The law builds on Hawaii’s Prepaid Health Care Act of 1975 (PHCA) which required nearly all employers to provide health insurance to employees working 20 or more hours a week for four consecutive weeks.2
Structure: The legislation established the Hawaii Health Connector as a non-profit corporation.
Governance: Governance: Beginning on July 1, 2012, the Connector transitioned from an interim board to a final 15-member board appointed by the Governor and with the advice and consent of the Senate. Four non-voting ex officio members (or their designees) are the Director of Commerce and Consumer Affairs, the Director of Health, the Director of Human Services, and the Director of Labor and Industrial Relations.
Current appointed Board members are:
- Hardy Spoehr (Chair), Papa Ola Lokahi
- Sherry Menor-McNamara (Vice-Chair), Chamber of Commerce of Hawaii
- Cliff Alakai (Treasurer), Maui Medical Group
- Gwen Rulona (Secretary), UFCW Local 480
- Clementina Ceria-Ulep, Faith Action Community Equity
- Joan Danieley, Kaiser Foundation Health Plan, Inc.
- Jennifer Diesman, Hawaii Medical Services Association
- Michael Gleason, The Arc of Hilo
- Robert Hirokawa, Hawaii Primary Care Association
- Faye Kurren, Hawaii Dental Service
- Christine Mai`i Sakuda, Hawaii Health Information Exchange
In December 2011, the Interim Board hired an Executive Director.
The Connector’s bylaws require the development of five standing committees: Audit and Finance, Legal Policy, Data Access and Technical Infrastructure, Community Outreach, and Community Advisory.3 The Interim Board also voted to create a standing Individual and Employer Consumer Advisory Committee in April 2012 and the permanent Board voted to create a Governance Committee in July 2012.4
In May 2012, the Connector issued conflicts of interest policies, building on those set by the Interim Board in the previous year.5 The policies require that employees and Board Members of the Connector recuse themselves from any decision or discussion in which they believe they have a conflict of interest.
Contracting with Plans: The Connector will serve “as a clearinghouse for information on all qualified plans and qualified dental plans listed or included in the Connector.” The decision to operate the Connector as a clearinghouse was reaffirmed in November 2012, though the question will be revisited if there are additional entrants to the insurance market.6 In addition, the Insurance Commissioner will retain full regulatory jurisdiction over plans and determine inclusion eligibility, provided that all qualified health plans (QHPs) that apply are included in the Connector.
In December 2011, the Interim Board recommended that insurers offering qualified health plans (QHPs) through the Connector’s small group market should be required to offer QHPs through the Connector’s individual market.7 The Insurance Commissioner should be empowered to grant waivers to insurers able to demonstrate that compliance with this requirement would increase the risk of insolvency or financial hardship. In addition, insurers offering QHPs through the Connector should be required to offer the plans to all consumers in all geographic areas of the state.
The Connector anticipates requesting that issuers indicate their intent to submit QHPs by February 2013.8 The following month, issuers will begin submitting QHPs for qualification by the Department of Commerce and Consumer Affairs and for certification by the Connector. By July, the Connector’s review and certification process for the 2014 plan year will be complete. QHPs will be posted on the website as early as September and open enrollment will begin on October 1.
Risk Adjustment, Reinsurance, and Risk Corridors: Hawaii intends to use federal government services to administer its risk adjustment and reinsurance programs.9
Consumer Assistance and Outreach: The Connector initiated an outreach effort to build relationships with community members, contact hard-to-reach populations, and identify where additional resources will be needed.10 In December 2012, the Connector procured subcontractor assistance with market research, development of a communication strategy (including public outreach and educational materials), and public relations.11
The Connector has also begun planning for a call center that focuses on the exchange and transfers questions related to Medicaid and the Children’s Health Insurance Program (CHIP) to an existing call center within the Department of Human Services (DHS).12 It is possible that the functionality of the two call centers will be combined at a later date. The Connector has left open the possibility of asking the winner of the information technology RFP to establish the call center that would respond to requests from individuals, employers, employees, Navigators, and brokers.
The Interim Board recommended that Navigators should be restricted to nonprofit organizations in Hawaii in order to avoid conflict of interest.13 Insurance producers should be prohibited from serving as Navigators. However, in recognition of the role that insurance producers play in the state regarding the sale of insurance products to small business owners, insurance producers should be allowed to sell insurance products available through the Connector.
Small Business Health Options Program (SHOP) Exchange: In November 2012, the Connector confirmed that the definition of a small business is 100 or fewer employees.14 In addition, the Connector has been in communication with other state agencies and the federal government to integrate current law requirements in Hawaii, specifically the PHCA, with compliance with the ACA.15
The Board also discussed the need for a feasibility study to determine the impact of outsourcing SHOP premium aggregation versus maintaining that function in-house.16 The Connector does not plan to perform premium aggregation in the individual exchange, unless it is demonstrated that there are cost efficiency benefits.
Information Technology (IT): On April 20, 2012, the Connector procured subcontractor assistance with the first phase of IT development, including project management and development of a concept plan for the IT system and architecture. In May, the Connector held Joint Application Development (JAD) sessions with multiple state agency and stakeholder groups to discuss a second IT RFP, which was released in July. This RFP includes implementation, maintenance, and operation of the enterprise exchange system suite of software and services for both the individual exchange and the Small Business Health Options Program (SHOP) exchange.17 The contract was awarded at the end of 2012 and extends over four years, after which operations will likely transfer gradually to the Connector or possibly another bidder. An RFP for Independent Verification and Validation of the Exchange project was released on October 29, 2012, and awarded the following month.18
Previous assessments of Hawaii’s current technical infrastructure concluded that the state could not host an integrated IT solution and still meet federal deadlines. For that reason, bidders have been requested to plan a system that interfaces with the federal and state eligibility systems and databases, as well as with issuers of insurance plans. Specifically, the Connector will exchange data with the DHS’ eligibility system, which will be responsible for determining eligibility for Medicaid, CHIP, premium and cost sharing subsidies. The state is procuring assistance with replacing the existing DHS eligibility system, called the Hawaii Automated Welfare Information System, separately from the Connector’s IT RFP. The new DHS eligibility system is expected to be scalable and flexible in order to support other public programs, such as the Supplemental Nutritional Assistance Program (SNAP) and Temporary Assistance to Needy Families (TANF). To assist in financing the information technology upgrades of the state’s Medicaid eligibility systems, Hawaii applied for and received CMS approval of an Advanced Planning Document to receive enhanced federal funding.19
The Hawaii Insurance Department (HID) and Hawaii Department of Commerce and Consumer Affairs (DCCA) will be responsible for certification and qualification of the QHPs. The HID currently uses the System for Electronic Rate and Form Filing (SERFF), an IT system that contains information about the health insurance issuers, rate, plans, and provider networks. The Connector’s IT system is expected to interface with the SERFF system.
Essential Health Benefits (EHB): The Affordable Care Act requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through an exchange, cover certain defined health benefits. The Governor’s office partnered with the DCCA and DHS to examine possible EHB plans and collect feedback through two public forums. On October 1, 2012, the Governor announced that the state had selected the HMSA Preferred Provider Plan 2010 as the EHB benchmark.20
The Hawaii DCCA received a federal Exchange Planning grant of $1 million. In November 2011, the DCCA awarded a Level One Establishment grant of $14.4 million to create a web portal for the Connector.21 In August 2012, the Department of Health and Human Services was awarded a second Level One Establishment grant of $61.8 million to support outreach efforts, design and develop IT architecture and engage a quality assurance The Connector requested that the federal government reassign the grant money, originally provided to the DCCA.22
The Connector may apply for other grants and receive funding from other public or private sources. In addition, the state may decide to appropriate money to the Connector. The Connector may also charge participating plans assessments or user fees.
Expansion of Medicaid
From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.
As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.
However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.
Hawaii is participating in Medicaid expansion.
On January 3, 2013, Hawaii received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a state-based exchange.23 Final approval is contingent upon the state demonstrating its ability to perform all required exchange activities on time, complying with future guidance and regulations, submitting a timeline mapping policy and technical decisions, developing memoranda of understanding between the Connector and other state partners, and developing and activating a contingency plan for eligibility and enrollment functions should the Connector be unable to demonstrate the ability to perform these functions with the existing plan by the end of January.
The Hawaii Health Connects website is http://hawaiihealthconnector.com/.
1. SB 1348. (Public Act 205). The Hawaii Health Insurance Exchange Act of 2011. http://www.capitol.hawaii.gov/session2011/bills/GM1309_.pdf
2. Chapter 393. Hawaii’s Prepaid Health Care Act of 1975.http://www.capitol.hawaii.gov/hrscurrent/Vol07_Ch0346-0398/HRS0393/HRS_0393-.htm
3. Hawaii Health Connector, “Amended and Restated Bylaws.” May 11, 2012.http://www.hawaiihealthconnector.com/uploads/Hawaii_Health_Connector_-_Bylaws.pdf
4. Hawaii Health Connector. Minutes from the Meeting of the Board of Directors. July 12, 2012.
5. Hawaii Health Connector, “Conflicts of Interest and Code of Conduct Policies.” Effective May 22, 2012.http://www.hawaiihealthconnector.com/uploads/Hawaii_Health_Connector_-_Conflicts_of_Interest_Policy.pdf
6. Hawai’i Health Connector. Strategic Decision Analysis. UPDATE: Active Purchaser versus Clearinghouse. Presented at a Consumer Advisory meeting on November 9, 2012.http://www.hawaiihealthconnector.com/uploads/Additional_Documents_Consumer_Advisory_12.04.2012.zip
7. Hawai’i Health Connector Interim Board of Directors. “Report to the 2012 Legislature.” December 29, 2011.
8. Hawai’i Health Connector. Strategic Decision Analysis. UPDATE: Plan Management. Presented at a Consumer Advisory meeting on November 9, 2012.http://www.hawaiihealthconnector.com/uploads/Additional_Documents_Consumer_Advisory_12.04.2012.zip
9. Press release. “Governor Affirms Commitment to a State-based Health Insurance Exchange.” June 7, 2012.http://www.hawaiihealthconnector.com/uploads/News_Release_061312.pdf
10. Hawaii Health Connector News. August 21, 2012.http://www.hawaiihealthconnector.com/uploads/HHCeNews82112.pdf
11. Hawai’i Health Connector RFP no. 2012-.003. “Market Research, Communication Strategy, and Public Relations.” September 5, 2012. http://www.hawaiihealthconnector.com/uploads/RFP_No__2012-03_-_PR_Services__Final_Distribution_Copy_.pdf
12. Hawaii Health Connector. Health Insurance Exchange Implementation Project. Request for Proposals # 2012-002. Release date July 16, 2012. http://www.hawaiihealthconnector.com/Public_Notices.html
13. Hawai’i Health Connector Interim Board of Directors. “Report to the 2012 Legislature.” December 29, 2011.
14. Hawai’i Health Connector, Minutes from the meeting of the Board of Directors. November 9, 2012.http://www.hawaiihealthconnector.com/uploads/Minutes_11092012.pdf
15. Hawai’i Health Connector. Strategic Decision Analysis. UPDATE: Determining the Small Business Size. Understanding the Dual Rules Environment. Presented at a Consumer Advisory meeting on November 9, 2012.http://www.hawaiihealthconnector.com/uploads/Additional_Documents_Consumer_Advisory_12.04.2012.zip
16. Hawai’I Health Connector, Strategic Decision Analysis: Individual Aggregation and SHOP Premium Aggregation. November 20, 2012.http://www.hawaiihealthconnector.com/uploads/Additional_Documents_Board_Meeting_11.30.2012.zip
17. Hawaii Health Connector. Health Insurance Exchange Implementation Project. Request for Proposals # 2012-002. http://www.hawaiihealthconnector.com/uploads/RFP_2012-002_HHC_Exchange_Implementation_Project.zip
18. Hawai’i Health Connector. Independent Verification & Validation of the Health Insurance Exchange Implementation Project. REFP # 2012/004http://www.hawaiihealthconnector.com/uploads/NR_HIHContracts_FINAL12072012.pdf
19. Heberlein M, et al. “Performing Under Pressure: Annual Findings of a 50-State Survey of Eligibility, Enrollment, Renewal, and Cost-Sharing Policies in Medicaid and CHIP, 2011-2012” Kaiser Commission on Medicaid and the Uninsured. (January; #8272). http://www.kff.org/medicaid/upload/8272.pdf
20. Press release from Governor Abercrombie. “Hawai’i Selects Healthcare Benefits Package.” October 1, 2012.http://hawaii.gov/gov/newsroom/press-releases/hawaii-selects-healthcare-benefits-package
21. U.S. Department of Health and Human Services. “Hawaii Affordable Insurance Exchange Grants Award List.” Accessed August 24, 2012. http://www.healthcare.gov/news/factsheets/2011/05/exchanges/hi.html .
22. Hawaii Health Connector. Minutes from the Meeting of the Board of Directors. July 12, 2012.
23. Letter from Secretary Sebelius to Governor Abercrombie. January 3, 2013.http://cciio.cms.gov/resources/files/hi-blueprint-exchange-letter-01-03-2013.pdf
Provided by the Henry J. Kaiser Family Foundation