For policies, contracts, plans, and agreements issued or renewed after 12/31/2026, requires insurers, mutual benefit societies, and health maintenance organizations to provide coverage for standard fertility preservation services for persons undergoing medically necessary treatment that may cause iatrogenic infertility. (CD1)
Requires the Hawaii Employer-Union Health Benefits Trust Fund Board of Trustees to negotiate with health insurance carriers to ensure that 12% of monthly premium payments are paid directly to primary care providers. Requires the Department of Human Services Med-QUEST Division to allocate 12% of monthly premium payments directly to primary care providers.
Expands mandatory health insurance coverage for low-dose mammography for occult breast cancer to include any supplemental imaging deemed medically necessary for a patient of any age having an above-average risk for breast cancer as determined by the use of a risk-factor modeling tool. On or before 1/1/2026, expands mandatory health insurance coverage to include additional supplemental imaging for any patient, regardless of age, as deemed medically necessary by the patient's primary care provider. Effective 12/31/2050. (SD1)
Requires health insurance carriers to honor a patient's written assignment of benefits to a substance use disorder treatment provider. Prohibits health insurance contracts from including anti-assignment clauses that restrict or invalidate a patient's right to assign benefits. Authorizes the Insurance Commissioner to adopt rules and take enforcement action to ensure compliance. Requires the Insurance Commissioner to publish an annual summary. Allows providers to bring civil actions to compel payment and obtain injunctive relief, damages, interest, and attorneys' fees for violations. Deems violations to be unfair methods of competition and unfair or deceptive acts or practices. Requires insurers to furnish an explanation of benefits to the assigned provider upon request.
For taxable years beginning 1/1/2026, establishes a tiered nonrefundable tax credit for qualified taxpayer insurers that offer one or more federally qualified health savings account-eligible high deductible health plans in the State, under certain conditions, and increasing the tax credit to incentivize more plans being written for residents in rural medically underserved areas of the State. Requires qualified taxpayer insurers to match up to a certain amount of a policyholder's first-time contribution into a health savings account. Sunsets 12/31/2030. Effective 7/1/2050. (SD1)
Requires the Legislative Reference Bureau to conduct a study on best practices for the regulation of pharmacy benefit managers and reduction in prescription drug costs for health insurance plan beneficiaries. Requires a report to the Legislature. Effective 12/31/2050. (HD1)
Establishes requirements for the clinical review criteria and clinical practical guidelines used to establish step therapy protocols. Provides a process for a patient to request an exception to using step therapy protocols. Establishes insurance coverage requirements relating to the use of step therapy protocols and standards to appeal an adverse step therapy exception determination.
Removes discriminatory requirements for mandatory insurance coverage of in vitro fertilization procedures to create parity of coverage for same-sex couples, unmarried individuals, transgender persons, and opposite-sex couples for whom male infertility is the relevant factor. Requires the insured or the insured's dependent spouse to have a history of infertility of at least six months' duration, rather than five years. Includes need for medical intervention to conceive due to physiological or anatomical factors.
Beginning 1/1/2027, repeals the fourteen years and under age limit for health insurance coverage requirements for the diagnosis and treatment of autism. Repeals the maximum coverage benefit limit of $25,000 for applied behavioral analysis services.
Requires all accident and health or sickness insurers, mutual benefit societies, and health maintenance organizations operating in the State to adopt policies, procedures, and criteria for approving or denying requests for prior authorization that are the equivalent to the guidelines for prior authorization established by Medicare.
