Haw. Code R. § 12-12-73 - Coverage by the fund

Current through February, 2022

(a) Notwithstanding section 12-12-41(d), the premium supplementation fund shall provide benefits to an eligible employee whose employer has failed to provide coverage in the following manner:

(1) The eligible employee shall be deemed to have selected the most prevalent reimbursement plan if the services were obtained from a health care provider normally paid by such plan.

(2) The eligible employee shall be deemed to have selected the most prevalent fee for service plan if services were obtained from a fee for services health care provider.

(b) The premium supplementation fund shall reimburse the eligible employee for payment of fees based on subsection (a)(1) or (2) less the premium the employee would have paid for such coverage. A claim for reimbursement shall be filed on a form provided by the director within two years after such services are provided, and shall contain a certification by the eligible employee that the employer has refused a written request to provide the required benefits to the eligible employee. An employer shall be deemed to have refused to provide such benefits where the employer fails to contact such eligible employee within thirty calendar days after such eligible employee makes a written request to the employer for such benefits at the employer's place of business.

(c) Any employee who is eligible for or received benefits under other laws shall not be entitled to benefits under this section.

(d) The health care contractor with the most prevailing plan selected in the category of subsection (a)(1) or (2) shall assist the department, upon request, in arriving at the proper reimbursement to the eligible employee.

Notes

Haw. Code R. § 12-12-73

[Eff: 5/7/81] (Auth: HRS § 393-32) (Imp: HRS § 393-48)