Hawaii Regulations

The Hawaii Insurance Division has this FAQ section for small employers in regards to small employer fully-insured plans they may purchase on the insurance marketplace. Among other things, it informs them that any new plans sold (excluding transitional plans) must cover essential health benefits and comply with the Federal Parity Law.

The Hawaii Insurance Division issued a report (pdf | Get Adobe® Reader®) on the ramifications of requiring insurance plans to cover autism services, as required by SB 2054 from the 2014 Legislative Session. This report was prepared by Wakely Consulting Group, Inc. The report was to specifically include information about the prevalence of autism spectrum disorders (ASD), the intensity and frequency of treatments based on the severity of the ASD, and a tiered delivery model for applied behavior analysis (ABA). Some of the significant findings of the report are (there is much greater detail and analysis in the report itself in terms of how these broad figures were reached):

• 1 in 103 children have ASD, with 1 in 211 being classified as mild, 1 in 292 being classified as moderate, and 1 in 629 being classified as severe
• The estimate for yearly hours per child for ABA is 600, with an average of 499 for mild cases, an average of 518 for moderate cases, and an average of 731 for severe cases
• Overall utilization rates for ABA, as classified by ASD intensity and utilization type (look at the table on page 5 of the report for these percentages)
• The average ABA cost per hour: $108 for high utilization; $90 for middle utilization; $72 for low utilization
• The average estimate for the impact on insurance premiums of requiring autism coverage was $28 per year, per plan member