Section 17-1720.1-19 - Exemptions to a health plan's enrollment limit(a) The department may implement an enrollment limit on any health plan that has an enrollment equal to or exceeding the maximum enrollment allowed for the service area as determined by the department and the enrollment limit shall be effective at the start of and remain in effect for the benefit year.(b) Subject to approval by the department, a health plan may self-impose an enrollment limit, and the enrollment limit shall be effective when enrollment has reached the self-imposed limit as determined by the department.(c) When a health plan has an enrollment limit, the health plan may not be available for selection and shall not be available for auto-assignment until the restriction is lifted.(d) The following eligible individuals shall be exempt from a participating health plan's enrollment limit: (1) A newborn born to an enrolled individual shall be enrolled in the mother's health plan for a minimum of thirty (30) days, or if the mother is not eligible, enrolled in the health plan of the: (A) Youngest enrolled household member; or(B) Primary household member if there is no sibling enrolled.(2) An enrolled individual in a health plan with a waiting list for HCBS or personal assistance services-level I when another health plan in the same service area open to new members does not have a waitlist for these services;(3) An enrolled individual who lost eligibility for a period of six (6) months or less shall be re-enrolled into their previous health plan;(4) A child under Foster Care, previously under Foster Care, Kinship Guardianship or Subsidized Adoption; or(5) A newly determined eligible individual who has seen a PCP, exclusive to a capped health plan, within the previous six (6) months or longer as determined by the department.Haw. Code R. § 17-1720.1-19
[Eff 09/30/13] (Auth: HRS § 346-14; 42 C.F.R. §§430.25, 435.150, 438.50 ) (Imp: HRS § 346-14; 42 C.F.R. §§430.25, 435.150, 438.50 )