Hawaii Health Insurance Enforcement and Consumer Protections Grant Award

Cycle I Grant Application Summary

Hawaii Grantee: Hawaii Department of Commerce and Consumer Affairs

Award Date: October 31, 2016

Total Award: $1,210,906.86

Baseline Award: $476,998

Selected Market Reforms Amount: $600,000

Workload Award Amount: $133,908.86

• Section 2707 - The Hawaii Department of Commerce & Consumer Affairs will create an enhanced reporting system to identify potential areas of non-compliance leading to further market analysis and market conduct activities. Hawaii will enhance its website to receive better information and data from consumers and issuers to aid with consumer complaint investigations. The Department of Commerce & Consumer Affairs will also develop consumer friendly outreach information, such as fact sheets or Frequently Asked Questions (FAQs).

• Section 2713 – The Hawaii Department of Commerce & Consumer Affairs will create an enhanced reporting system to identify potential areas of non-compliance, provide information for further market analysis, and provide information for conducting market conduct activities. Hawaii will enhance its reporting system through substantive developments, staff training, and I.T. market analysis and market conduct software systems. The Department of Commerce & Consumer Affairs will enhance its website to aid with consumer complaint investigations and to better receive information and data from consumers and issuers. Hawaii will also develop consumer friendly outreach information, such as fact sheets or FAQs.

• Section 2718 - The Hawaii Department of Commerce & Consumer Affairs will create a system so it can verify, analyze and crosscheck Medical Loss Ratio (MLR) reporting, including cost elements, submitted by health insurance issuers. The enhanced system will identify potential areas of non-compliance, provide information for further market analysis, and provide information for conducting market conduct activities. Finally, Hawaii will enhance its website to aid with consumer complaint investigations.

• Section 2719 - The Hawaii Department of Commerce & Consumer Affairs plans to identify processes to enhance its I.T. system to support the consumer complaints investigations process and to assist with consumer friendly outreach. Hawaii will also provide staff training focused on analyzing complaint data and complaint ratios, reviewing company market analysis profiles, and understanding the relevance of financial data to market analysis in order to determine what regulatory action should be initiated in response to identified problems at a company. Staff will learn how to conduct a market conduct examination, identify required elements of a Market Conduct Examination Report, and learn how close a Market Conduct Examination. Staff will also learn how to review and make recommendations on the market practices of issuers and learn to analyze the impact on consumers.

• Section 2726 - The Hawaii Department of Commerce & Consumer Affairs will create an enhanced system to identify potential areas of noncompliance, which may then lead to further market analysis and market conduct activities. The Department of Commerce & Consumer Affairs will make enhancements to the consumer facing website to aid with consumer complaint investigations. Finally, Hawaii seeks to conduct a market research study to determine marketing related decision-making for consumer facing materials.