Health Insurance Information

Health insurance is a contract that requires your health insurer to pay some or all of your health care costs and medical expenses in exchange for a premium. Understanding your options can help save you time, money and frustration.

UNDERSTANDING HEALTH INSURANCE
It’s always a good idea to have health insurance to help cover medical expenses for illnesses and injuries. Use the resources below to understand terminology, your rights as a patient, and be on alert for health insurance scams.
(PDF) Health Insurance Glossary and Terms
(PDF) Hawaii Patients’ Bill of Rights
(PDF) Consumer Alerts

INDIVIDUALS & FAMILIES
If you don’t have health insurance through an employer, you can buy an individual health plan during the annual Open Enrollment period or see if you are eligible for a Special Enrollment Period through HealthCare.gov.
(PDF) Affordable Care Act in Hawaii
(PDF) ACA Individual Health Insurance Premium Comparison Publication

BUSINESS OWNERS
The Insurance Division regulates the insurance companies and plan offerings for statutory required coverages, excluding those required under the Prepaid Healthcare Act. For questions and complaints regarding a particular insurer or insurer offering, contact the Insurance Division. For general questions on prepaid healthcare (health insurance through an employer), workers’ compensation and temporary disability insurance, contact the Department of Labor & Industrial Relations (DLIR).
(PDF) Employer Group Health Plans in Hawaii
(PDF) Small Group Premium Comparison Publication

The ACA Small Business Health Options Program (“SHOP”) Marketplace is designed to facilitate the sale of health insurance to small businesses through DLIR.  Hawaii’s State Innovation Waiver under section 1332 of the Affordable Care Act was approved on December 30, 2016 and is effective for January 1, 2017 through December 31, 2021. Under this waiver, the ACA SHOP is not required in Hawaii and the ACA SHOP tax credits are replaced by the State’s Prepaid Health Care Premium Supplementation Program. For more information, please visit the link below.
ACA Small Business Health Options Program (SHOP) Information from DLIR

MEDICARE & MEDICAID
Medicare is federal health insurance for people age 65 and older, and for those who are on Social Security Disability Income or diagnosed with certain diseases, administered and overseen by the Centers for Medicare & Medicaid Services under the Department of Health and Human Services. If you have any The Insurance Division does regulate Medigap plans (also called Medicare Supplement) which is a way to get supplemental coverage in addition to Medicare Parts A and B, but is different from a Medicare Advantage plan.
(PDF) Medicare Supplement Insurance (Medigap) Companies

HOW TO FILE A COMPLAINT AGAINST A HEALTH INSURER OR HEALTH PLAN
Step One:

You may do one of the following:
1. Fill out and print the complaint form below.
2. Call our office at (808) 586-2804 and request a complaint form to be mailed to you.
(PDF) Health Insurance Complaint/Inquiry Form

Step Two:
Send the complaint form along with copies of any documents you feel will help establish your claim to the Health Insurance Branch. (PLEASE DO NOT SEND ORIGINALS)

Drop off your complaint form in person at:
Hawaii Insurance Division
Health Insurance Branch
335 Merchant Street, Room 213
Honolulu, HI 96813Mail:
Hawaii Insurance Division
Health Insurance Branch
PO Box 3614
Honolulu, HI 96811Or fax:
(808) 587-5379

CONTACT US
Still have more questions or need more help?
Call us at (808) 586-2970, 7:45 a.m. to 4:30 p. m., Monday – Friday or email us at: insurance@dcca.hawaii.gov.