Text of HI SB 954 (2017)

THE SENATE S.B. NO. 954 TWENTY-NINTH LEGISLATURE, 2017 STATE OF HAWAII A BILL FOR AN ACT RELATING TO HEALTH INSURANCE. BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF HAWAII: SECTION 1. Chapter 431, Hawaii Revised Statutes, is amended by adding to part I of article 10A two new sections to be appropriately designated and to read as follows: "§431:10A- Protection against insolvency. (a) Every contract for an accident and health or sickness insurance policy between an insurer and a provider of health care services shall be in writing and provide that in the event the insurer fails to pay for health care services as set forth in the contract, the insured shall not be liable to the provider for any sums owed by the insurer. If a contract with a provider has not been reduced to writing as required by this subsection or fails to contain the required prohibition, the provider shall not collect or attempt to collect from the insured sums owed by the insurer. No provider or its agent, trustee, or assignee may maintain any action at law against an insured to collect sums owed by the insurer. (b) The commissioner shall require that each insurer has a plan for handling insolvency that allows for continuation of benefits for the duration of the contract period for which premiums have been paid and continuation of benefits to insureds confined on the date of insolvency in an inpatient facility, until their discharge or expiration of benefits. In considering the plan, the commissioner may require: (1) Insurance to cover the expenses to be paid for continued benefits after the insolvency; (2) Provisions in provider contracts that obligate the provider to provide services for the duration of the period after the insurer's insolvency for which premium payment has been made and until the insured is discharged from the inpatient facility; (3) Insolvency reserves; (4) Acceptable letters of credit; or (5) Any other arrangement acceptable to the commissioner to ensure that benefits are continued as specified above. (c) An agreement to provide health care services between a provider and an insurer shall require that a provider give the organization at least sixty days' advance notice in the event of termination. §431:10A- Required disclaimer. Any limited benefit plan policy, application, or sales brochure that provides coverage for accident and sickness, excluding specified disease, long-term care, disability income, medicare supplement, dental, or vision shall disclose in a conspicuous manner and in not less than fourteen-point boldface type the following, or substantially similar, statement: "THIS IS NOT QUALIFYING HEALTH COVERAGE ("MINIMUM ESSENTIAL COVERAGE") THAT SATISFIES THE HEALTH COVERAGE REQUIRMENT OF THE AFFORDABLE CARE ACT. IF YOU DON'T HAVE MINIMUM ESSENTIAL COVERAGE, YOU MAY OWE AN ADDITIONAL PAYMENT WITH YOUR TAXES."" SECTION 2. Chapter 431, Hawaii Revised Statutes, is amended by adding to part II of article 16 a new section to be appropriately designated and to read as follows: "§431:16- Recoupment of assessment. (a) Each member insurer not subject to section 431:16-213 shall annually recoup the assessments paid in the preceding years by the insurer under this part. The recoupment shall be recovered by means of a surcharge on premiums charged for policies for life, dental, and accident and health or sickness insurance policies or contracts. Prior to recoupment, each member insurer shall submit its plan for recoupment to the commissioner for approval. The surcharge shall be at a uniform percentage rate reasonably calculated to recoup the assessment paid by the member insurer. Any excess recovery by a member insurer shall be credited pro rata to that member insurer's policyholders' premiums in the succeeding year unless there has been a subsequent assessment, in which case the excess will be used to pay the amount of the subsequent assessment. If a member insurer fails to recoup the entire amount of its assessment in the first year under the procedure provided in this section, it may repeat the procedure in succeeding years until the full assessment is recouped. (b) Each insurer shall provide to the Hawaii life and disability insurance guaranty association an accounting of its recoupments. The Hawaii life and disability insurance guaranty association shall compile the insurers' accountings and submit it as part of its annual report to the commissioner. (c) The amount of and reason for any surcharge shall be separately stated on any billing sent to an insured. The surcharge shall not be considered premiums for any other purpose including the determination of producer commissions. (d) An insurer shall not apply for recoupment for assessments if credits for assessments paid are sought under section 431:16-213." SECTION 3. Section 431:10-104, Hawaii Revised Statutes, is amended to read as follows: "§431:10-104 General readability requirements. In addition to any other requirements of law, no contract shall be delivered or issued for delivery in this State unless: (1) The text is in plain language[,] and achieving a minimum score of forty on the Flesch reading ease test or an equivalent score on any other comparable test prescribed by the commissioner under section 431:10-105(a); (2) The contract is printed, except for specification pages, schedules, and tables, in not less than ten- point type[, one point leaded]; (3) The style, arrangement, and general appearance of the contract give no undue prominence to any endorsements, riders, or other portions of the text; and (4) A table of contents or an index of principal sections is provided with the contract when the text consists of more than three thousand words printed on three or less pages or when the text has more than three pages, regardless of the total number of printed words[; and (5) For any short-term health insurance policies that impose preexisting conditions provisions, any policy, application, or sales brochure shall disclose in a conspicuous manner in not less than fourteen point bold face type the following statement: "THIS POLICY EXCLUDES COVERAGE FOR CONDITIONS FOR WHICH MEDICAL ADVICE, DIAGNOSIS, CARE, OR TREATMENT WAS RECOMMENDED OR RECEIVED DURING THE [insert exclusion period] IMMEDIATELY PRECEDING THE EFFECTIVE DATE OF COVERAGE."]." SECTION 4. Section 431:10A-118.3, Hawaii Revised Statutes, is amended by amending subsection (e) to read as follows: "(e) As used in this section unless the context requires otherwise: "Actual gender identity" means a person's internal sense of being male, female, a gender different from the gender assigned at birth, a transgender person, or neither male nor female. "Gender transition" means the process of a person changing the person's outward appearance or sex characteristics to accord with the person's actual gender identity. "Perceived gender identity" means an observer's impression of another person's actual gender identity or the observer's own impression that the person is male, female, a gender different from the gender [designed] assigned at birth, a transgender person, or neither male nor female. "Transgender person" means a person who has gender identity disorder or gender dysphoria, has received health care services related to gender transition, adopts the appearance or behavior of the opposite sex, or otherwise identifies as a gender different from the gender assigned to that person at birth." SECTION 5. Section 431:16-202, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows: "(a) The purpose of this part is to protect, subject to certain limitations, the persons specified in section 431:16-203 against failure in the performance of contractual obligations[,] under life [and], dental, and accident and health or sickness insurance policies and [annuity contracts] annuities specified in section 431:16-203(b), because of the impairment or insolvency of the member insurer that issued the policies or contracts." SECTION 6. Section 431:16-203, Hawaii Revised Statutes, is amended by amending subsections (b) and (c) to read as follows: "(b)(1) This part shall provide coverage to the persons specified in subsection (a) for direct, nongroup life, dental, or accident and health or sickness policies or [annuity policies or contracts] annuities, for certificates under direct group life, dental, or accident and health or sickness policies or [annuity policies or contracts] annuities, and for supplemental contracts to any of these, in each case issued by member insurers except as limited by this part. Annuity contracts and certificates under group [annuity contracts] annuities include allocated funding agreements, structured settlement annuities, and any immediate or deferred [annuity contracts] annuities. (2) This part shall not provide coverage for: (A) Any portion of a policy or contract not guaranteed by the insurer, or under which the risk is borne by the policy or contract owner; (B) Any policy or contract of reinsurance, unless assumption certificates have been issued pursuant to the reinsurance policy or contract; (C) Any portion of a policy or contract to the extent that the rate of interest on which it is based: (i) Averaged over the period of four years prior to the date on which the association becomes obligated with respect to such policy or contract, exceeds a rate of interest determined by subtracting two percentage points from Moody's Corporate Bond Yield Average averaged for that same four-year period or for such lesser period if the policy or contract was issued less than four years before the association became obligated; and (ii) On or after the date on which the association becomes obligated with respect to such policy or contract, exceeds the rate of interest determined by subtracting three percentage points from Moody's Corporate Bond Yield Average as most recently available; (D) Any portion of a policy or contract issued to a plan or program of an employer, association, or other person to provide life, dental, accident and health or sickness, or annuity benefits to its employees, members, or other persons to the extent that the plan or program is self-funded or uninsured, including but not limited to benefits payable by an employer, association, or other person under: (i) A Multiple Employer Welfare Arrangement as defined in section 514 of the Employee Retirement Income Security Act of 1974, as amended; (ii) A minimum premium group insurance plan; (iii) A stop-loss group insurance plan; or (iv) An administrative services only contract; (E) Any portion of a policy or contract to the extent that it provides dividends, experience rating credits, or voting rights, or provides that any fees or allowances be paid to any person, including the policy or contract holder, in connection with the service to or administration of such policy or contract; (F) Any policy or contract issued in this State by a member insurer at a time when it was not licensed or did not have a certificate of authority to issue such policy or contract in this State; (G) Any portion of a policy or contract to the extent that the assessments required by this part with respect to the policy or contract are preempted or otherwise not permitted by federal or state law; (H) Any obligation that does not arise under the express written terms of the policy or contract issued by the insurer to the contract owner or policy owner, including without limitation: (i) Claims based on marketing materials; (ii) Claims based on side letters, riders, or other documents that were issued by the insurer without meeting applicable policy form filing or approval requirements; (iii) Misrepresentations of or regarding policy benefits; (iv) Extra-contractual claims; or (v) A claim for penalties or consequential or incidental damages; (I) Any contractual agreement that establishes the member insurer's obligations to provide a book value accounting guaranty for defined contribution benefit plan participants by reference to a portfolio of assets that is owned by the benefit plan or its trustee, which in each case is not an affiliate of the member insurer; (J) Any unallocated [annuity contract] annuity; (K) Any portion of a policy or contract to the extent it provides for interest or other changes in value to be determined by the use of an index or other external reference stated in the policy or contract, but that have not been credited to the policy or contract, or as to which the policy or contract owner's rights are subject to forfeiture, as of the date the member insurer becomes an impaired or insolvent insurer under this part. If a policy's or contract's interest or changes in value are credited less frequently than annually, then for purposes of determining the values that have been credited and are not subject to forfeiture under section 431:16-403(b)(2)(L), the interest or change in value determined by using the procedures defined in the policy or contract shall be credited as if the contractual date of crediting interest or changing values was the date of impairment or insolvency and shall not be subject to forfeiture; or (L) Any policy or contract providing any hospital, medical, prescription drug, dental, or other health care benefits pursuant to part C or part D of subchapter XVIII, chapter 7, title 42 of the United States Code, commonly known as medicare part C and D, or any regulations adopted pursuant thereto. (c) The benefits for which the association may become liable shall in no event exceed the lesser of: (1) The contractual obligations for which the insurer is liable or would have been liable if it were not an impaired or insolvent insurer, or (2) With respect to any one life, regardless of the number of policies or contracts: (A) $300,000 in life insurance death benefits, but not more than $100,000 in net cash surrender and net cash withdrawal values for life insurance; (B) In accident and health or sickness insurance benefits: (i) $100,000 for coverages not defined as disability insurance or basic hospital, medical, and surgical insurance, or major medical insurance or long-term care insurance, including any net cash surrender and net cash withdrawal values; (ii) $300,000 for disability insurance and $300,000 for long-term care insurance; or (iii) $500,000 for basic hospital, medical, and surgical insurance or major medical insurance; (C) $3,000 per dental insurance policy per year; [(C)] (D) $250,000 in the present value of annuity benefits, including net cash surrender and net cash withdrawal values; or [(D)] (E) With respect to each payee of a structured settlement annuity, or beneficiary or beneficiaries of the payee if deceased, $250,000 in present value annuity benefits, in the aggregate, including net cash surrender and net cash withdrawal values, if any." SECTION 7. Section 431:16-205, Hawaii Revised Statutes, is amended by amending the definitions of "member insurer" and "supplemental contract" to read as follows: ""Member insurer" means any insurer licensed or who holds a certificate of authority to transact in this State any kind of insurance for which coverage is provided under section 431:16‑203, and includes any insurer whose license or certificate of authority in this State may have been suspended, revoked, not renewed, or voluntarily withdrawn, but does not include: [(1) A nonprofit hospital or medical service organization; (2) A health maintenance organization; (3)] (1) A fraternal benefit society; [(4)] (2) A mandatory state pooling plan; [(5)] (3) A mutual assessment company or any entity that operates on an assessment basis; [(6)] (4) An insurance exchange; [(7)] (5) An organization that has a certificate or license limited to the issuance of charitable gift annuities; or [(8)] (6) Any entity similar to any of the above. "Supplemental contract" means a written agreement entered into for the distribution of proceeds under a life, dental, or health [, or annuity] policy or [life, health, or annuity] contract or an annuity." SECTION 8. Section 431:16-206, Hawaii Revised Statutes, is amended by amending subsection (a) to read as follows: "(a) There is created a nonprofit legal entity to be known as the Hawaii life and disability insurance guaranty association. All member insurers shall be and remain members of the association as a condition of their authority to transact insurance in this State. The association shall perform its functions under the plan of operation established and approved under section 431:16-210 and shall exercise its powers through a board of directors established under section 431:16-207. For purposes of administration and assessment the association shall maintain [three] four accounts: (1) The life insurance account; (2) The accident and health or sickness insurance account; [and] (3) The annuity account[.]; and (4) The dental insurance account." SECTION 9. Section 431:16-208, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows: "(b) If a member insurer is an insolvent insurer, the association shall, in its discretion: (1) (A) Guarantee, assume, or reinsure, or cause to be guaranteed, assumed, or reinsured, the policies or contracts of the insolvent insurer; or (B) Assure payment of the contractual obligations of the insolvent insurer; and (C) Provide such moneys, pledges, guarantees, or other means as are reasonably necessary to discharge such duties; or (2) Provide benefits and coverages in accordance with the following provisions: (A) With respect to life, dental, and accident and health or sickness insurance policies and annuities, assure payment of benefits for premiums identical to the premiums and benefits (except for terms of conversion and renewability) that would have been payable under the policies of the insolvent insurer, for claims incurred: (i) With respect to group policies and contracts, not later than the earlier of the next renewal date under the policies or contracts or forty-five days, but in no event less than thirty days, after the date on which the association becomes obligated with respect to the policies; and (ii) With respect to non-group policies, contracts, and annuities, not later than the earlier of the next renewal date (if any) under the policies or contracts or one year, but in no event less than thirty days, from the date on which the association becomes obligated with respect to the policies or contracts. (B) Make diligent efforts to provide all known insureds or annuitants (for non-group policies and contracts), or group policy owners with respect to group policies and contracts, thirty days' notice of the termination of the benefits provided. (C) With respect to non-group life [and], dental, and accident and health or sickness insurance policies and annuities covered by the association, make available to each known insured or annuitant, or owner if other than the insured or annuitant, and with respect to an individual formerly insured or formerly an annuitant under a group policy who is not eligible for replacement group coverage, make available substitute coverage on an individual basis in accordance with subparagraph (D), if the insureds or annuitants had a right under law or the terminated policy to convert coverage to individual coverage or to continue an individual policy or annuity in force until a specified age or for a specified time, during which the insurer had no right unilaterally to make changes in any provision of the policy or annuity or had a right only to make changes in premium by class. (D) (i) In providing the substitute coverage required under subparagraph (C), the association may offer either to reissue the terminated coverage or to issue an alternative policy. (ii) Alternative or reissued policies shall be offered without requiring evidence of insurability, and shall not provide for any waiting period or exclusion that would not have applied under the terminated policy. (iii) The association may reinsure any alternative or reissued policy. (E) (i) Alternative policies adopted by the association shall be subject to the approval of the domiciliary commissioner or the receivership court. The association may adopt alternative policies of various types for future issuance without regard to any particular impairment or insolvency. (ii) Alternative policies shall contain at least the minimum statutory provisions required in this State and provide benefits that shall not be unreasonable in relation to the premium charged. The association shall set the premium in accordance with a table of rates which it shall adopt. The premium shall reflect the amount of insurance to be provided and the age and class of risk of each insured, but shall not reflect any changes in the health of the insured after the original policy was last underwritten. (iii) Any alternative policy issued by the association shall provide coverage of a type similar to that of the policy issued by the impaired or insolvent insurer, as determined by the association. (F) If the association elects to reissue terminated coverage at a premium rate different from that charged under the terminated policy, the premium shall be set by the association in accordance with the amount of insurance provided and the age and class of risk, subject to approval of the domiciliary insurance commissioner or by a court of competent jurisdiction. (G) The association's obligations with respect to coverage under any policy of the impaired or insolvent insurer or under any reissued or alternative policy shall cease on the date such coverage or policy is replaced by another similar policy by the policyholder, the insured, or the association. (H) When proceeding under subsection (b)(2) with respect to any policy or contract carrying guaranteed minimum interest rates, the association shall assure the payment or crediting of a rate of interest consistent with section 431:16-203(b)(2)(C)." SECTION 10. Section 431:16-209, Hawaii Revised Statutes, is amended by amending subsection (c) to read as follows: "(c)(1) The amount of any Class A assessment shall be determined by the board of directors and may be authorized and called on a pro rata or non-pro rata basis. If pro rata, the board of directors may provide that it be credited against future Class B assessments. A non-pro rata assessment shall not exceed $300 per member insurer in any one calendar year. The amount of any Class B assessment shall be allocated for assessment purposes among the accounts pursuant to an allocation formula which may be based on the premiums or reserves of the impaired or insolvent insurer or any other standard deemed by the board of directors in its sole discretion as being fair and reasonable under the circumstances. (2) Class B assessments against member insurers for [each] the account to which each is assigned shall be in the proportion that the premiums received on business in this State by each assessed member insurer on policies or contracts covered [by each] in the assigned account for the three most recent calendar years for which information is available preceding the year in which the insurer became impaired or insolvent, as the case may be, bears to the premiums received on business in this State for the calendar years by [all] the assessed member insurers. (3) Assessments for funds to meet the requirements of the association with respect to an impaired or insolvent insurer shall not be authorized or called until necessary to implement the purposes of this part. Classification of assessments under subsection (b) and computation of assessments under this subsection shall be made with a reasonable degree of accuracy, recognizing that exact determinations may not always be possible. The association shall notify each member insurer in the assigned account of its anticipated pro rata share of an authorized assessment not yet called within one hundred eighty days after the assessment is authorized." SECTION 11. Section 431:16-209, Hawaii Revised Statutes, is amended by amending subsection (e) to read as follows: "(e)(1) Subject to the provisions of paragraph (2), the total of all assessments authorized by the association with respect to a member insurer [for] in each account shall not in any one calendar year exceed two per cent of the insurer's average premiums received in this State on the policies and contracts covered by the account during the three calendar years preceding the year in which the insurer became an impaired or insolvent insurer. (2) If two or more assessments are authorized in one calendar year with respect to insurers that become impaired or insolvent in different calendar years, the average annual premiums for purposes of the aggregate assessment percentage limitation referenced in this section shall be equal and limited to the higher of the three-year average annual premiums for the applicable account as calculated pursuant to this section. (3) If the maximum assessment, together with the other assets of the association in any account, does not provide in any one year in either account an amount sufficient to carry out the responsibilities of the association, the necessary additional funds shall be assessed as soon thereafter as permitted by this part. The board of directors may provide in the plan of operation a method of allocating funds among claims, whether relating to one or more impaired or insolvent insurers, when the maximum assessment will be insufficient to cover anticipated claims." SECTION 12. Section 431:16-210, Hawaii Revised Statutes, is amended by amending subsection (c) to read as follows: "(c) The plan of operation shall, in addition to requirements enumerated elsewhere in this part: (1) Establish procedures for handling the assets of the association; (2) Establish the amount and method of reimbursing members of the board of directors under section 431:16-207(c); (3) Establish regular places and times for meetings, including telephone conference calls of the board of directors; (4) Establish procedures for records to be kept of all financial transactions of the association, its agents, and the board of directors; (5) Establish the procedures whereby selections for the board of directors will be made and submitted to the commissioner; (6) Establish any additional procedures for assessments under section 431:16-209; (7) Contain additional provisions necessary or proper for the execution of the powers and duties of the association; (8) Establish procedures to remove a director for cause, including the case in which a director is affiliated with a member insurer that becomes an impaired or insolvent insurer; [and] (9) Require the board of directors to establish a policy and procedure for addressing conflicts of interests[.]; and (10) Establish notification procedures for assigning insurers to their respective accounts under section 431:16-206. " SECTION 13. Section 431:16-213, Hawaii Revised Statutes, is amended to read as follows: "§431:16-213 Credits for assessments paid. (a) [A] If applicable, a member insurer may offset against its premium tax liability (or liabilities) to this State an assessment described in section 431:16-209(h) to the extent of twenty per cent of the amount of such assessment for each of the five calendar years following the year in which such assessment was paid. In the event a member insurer should cease doing business, all uncredited assessments may be credited against its premium tax liability (or liabilities) for the year it ceases doing business. (b) Any sums which are acquired by refund, pursuant to section 431:16-209(f), from the association by member insurers, and which have theretofore been offset against premium taxes as provided in subsection (a) shall be paid by the association to the commissioner and by the commissioner deposited with the state director of finance for credit to the general fund of this State. (c) An insurer shall not apply for credits for assessments paid if recoupment for assessments are sought under section 431:16- ." SECTION 14. Section 431:16-218, Hawaii Revised Statutes, is amended to read as follows: "§431:16-218 Prohibited advertisement of association act in insurance sales; notice to policyholders. (a) No person, including an insurer[,] and [a] its producer or affiliate [of an insurer], shall make, publish, disseminate, circulate, or place before the public[,] or cause directly or indirectly[,] to be made, published, disseminated, circulated, or placed before the public, in any newspaper, magazine, or other publication, [or in the form of a notice, circular, pamphlet, letter, or poster, or] over any radio station or television station, or in any other way, any oral or written advertisement, announcement, or statement[, written or oral, which] that uses the [existence of the] Hawaii life and disability insurance guaranty association [of this State] for [the purpose of] sales, solicitation, or inducement to purchase any form of insurance covered by the Hawaii Life and Disability Insurance Guaranty Association Act. This section shall not apply to the Hawaii life and disability insurance guaranty association or any other entity [which] that does not sell or solicit insurance. (b) Within one hundred eighty days of July 1, 1988, the association shall prepare a summary document describing the general purposes and current limitations of this part and complying with subsection (c). This document shall be submitted to the commissioner for approval. Sixty days after receiving [such] the approval, no insurer may deliver a policy or contract described in section 431:16-203 to a policyholder or contract holder unless the document is delivered to the policyholder or contract holder at the time of delivery of the policy or contract, except if subsection (d) applies. The document [should] shall also be available upon request by a policyholder. The distribution, delivery [or], contents, or interpretation of this document shall not mean that [either] the policy [or the], contract, or [the] its holder [thereof] would be covered in the event of the impairment or insolvency of a member insurer. The description document shall be revised by the association as amendments to this part may require. Failure to receive this document does not give the policyholder, contract holder, certificate holder, or insured any greater rights than those stated in this part. (c) The document prepared under subsection (b) shall contain a clear and conspicuous disclaimer on its face. The commissioner shall promulgate a rule establishing the form and content of the disclaimer[. The disclaimer] that shall: (1) State the name and address of the Hawaii life and disability insurance guaranty association and the insurance division; (2) Prominently warn the policy or contract holder that the Hawaii life and disability insurance guaranty association may not cover the policy or, if coverage is available, [it] the policy will be subject to substantial limitations and exclusions and be conditioned on continued residence in this State; (3) State that the insurer and its producers are prohibited by law from using the [existence of the] Hawaii life and disability insurance guaranty association for [the purpose of] sales, solicitation, or inducement to purchase any form of insurance; (4) Emphasize that the policy or contract holder should not rely on coverage under the Hawaii life and disability insurance guaranty association when selecting an insurer; and (5) Provide other information as directed by the commissioner. (d) No insurer or producer may deliver a policy or contract described in section 431:16-203(b)(1) and excluded under section 431:16-203(b)(2)(A) from coverage under this part, unless the insurer or producer, prior to or at the time of delivery, gives the policy or contract holder a separate written notice [which] that clearly and conspicuously discloses that the policy or contract is not covered by the Hawaii life and disability insurance guaranty association. The commissioner shall by rule specify the form and content of the notice." SECTION 15. Section 432:1-102, Hawaii Revised Statutes, is amended by amending subsection (b) to read as follows: "(b) Article 2, article 2D, parts II and IV of article 3, article 6, part III of article 7, article 9A, article 13, article 14G, [and] article 15, and article 16 of chapter 431, sections 431:3-301, 431:3-302, 431:3-303, 431:3-304, 431:3-305, 431:10-102, 431:10-225, 431:10-226.5, and 431:10A-116(1) and (2), and the powers granted by those provisions to the commissioner[,] shall apply to managed care plans, health maintenance organizations, or medical indemnity or hospital service associations that are owned or controlled by mutual benefit societies, so long as the application in any particular case is in compliance with and [is] not preempted by applicable federal statutes and regulations." SECTION 16. Section 432:1-607.3, Hawaii Revised Statutes, is amended by amending subsection (e) to read as follows: "(e) As used in this section unless the context requires otherwise: "Actual gender identity" means a person's internal sense of being male, female, a gender different from the gender assigned at birth, a transgender person, or neither male nor female. "Gender transition" means the process of a person changing the person's outward appearance or sex characteristics to accord with the person's actual gender identity. "Perceived gender identity" means an observer's impression of another person's actual gender identity or the observer's own impression that the person is male, female, a gender different from the gender [designed] assigned at birth, a transgender person, or neither male nor female. "Transgender person" means a person who has gender identity disorder or gender dysphoria, has received health care services related to gender transition, adopts the appearance or behavior of the opposite sex, or otherwise identifies as a gender different from the gender assigned to that person at birth." SECTION 17. Section 432D-19, Hawaii Revised Statutes, is amended to read as follows: "§432D-19 Statutory construction and relationship to other laws. (a) Except as provided in subsection (d) and otherwise provided in this chapter, the insurance laws and hospital or medical service corporation laws of this State shall not apply to the activities authorized and regulated under this chapter of any health maintenance organization granted a certificate of authority under this chapter. This chapter shall not apply to an insurer or a hospital or medical service corporation licensed and regulated pursuant to the insurance laws or [the] hospital or medical service corporation laws of this State, except with respect to [its] health maintenance organization activities authorized and regulated pursuant to this chapter. (b) Solicitation of enrollees by a health maintenance organization granted a certificate of authority[,] or by its representatives[,] shall not be construed to violate any [provision of] law relating to solicitation or advertising by health professionals. (c) Any health maintenance organization granted a certificate of authority under this chapter shall not be deemed to be practicing medicine or osteopathic medicine and shall be exempt from the provision [of] in chapter 453 relating to the practice of medicine or osteopathic medicine. (d) Article 2, article 2D, part IV of article 3, article 6, part III of article 7, article 9A, article 13, article 14G, [and] article 15, and article 16 of chapter 431, and sections 431:3-301, 431:3-302, 431:3-303, 431:3-304, 431:3-305, 431:10-225, and 431:10-226.5, and the powers granted by those provisions to the commissioner shall apply to health maintenance organizations, so long as the application in any particular case is in compliance with and [is] not preempted by applicable federal statutes and regulations." SECTION 18. Section 432D-26.3, Hawaii Revised Statutes, is amended by amending subsection (e) to read as follows: "(e) As used in this section unless the context requires otherwise: "Actual gender identity" means a person's internal sense of being male, female, a gender different from the gender assigned at birth, a transgender person, or neither male nor female. "Gender transition" means the process of a person changing the person's outward appearance or sex characteristics to accord with the person's actual gender identity. "Perceived gender identity" means an observer's impression of another person's actual gender identity or the observer's own impression that the person is male, female, a gender different from the gender [designed] assigned at birth, a transgender person, or neither male nor female. "Transgender person" means a person who has gender identity disorder or gender dysphoria, has received health care services related to gender transition, adopts the appearance or behavior of the opposite sex, or otherwise identifies as a gender different from the gender assigned to that person at birth." SECTION 19. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored. SECTION 20. This Act shall take effect upon its approval. INTRODUCED BY: _____________________________ BY REQUEST Report Title: Health Care Provider; Accident and Health or Sickness Insurance; Insolvency; Continuation of Benefits; Limited Benefit Plan; Short-Term Health Insurance; Preexisting Condition; Disclaimer; Affordable Care Act; General Readability Requirements; Flesch Reading Ease Test; Perceived Gender Identity; Life and Disability Insurance Guaranty Association; Member Insurer Description: Updates Hawaii Revised Statutes title 24 by: requiring health care providers to continue providing services during a health insurer insolvency; moving the short-term health insurance preexisting disclosure requirement from section 431:10-104(5) to chapter 431, article 10A; amending the definition of "perceived gender identity" to correct a technical drafting error; including health insurers as part of the guaranty association; and making technical, nonsubstantive amendments for clarity and consistency. The summary description of legislation appearing on this page is for informational purposes only and is not legislation or evidence of legislative intent.