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Hawaii

Refusal to Provide Medical Services

ABORTION REFUSAL CLAUSE

Hawaii allows certain individuals or entities to refuse to provide abortion services.

To whom does the refusal clause apply?  Individuals and hospitals.

What does the refusal clause allow?  No person or hospital may be required to participate in abortion services.  No person or hospital may be liable for refusing to participate.

Does the law require the refusing individual or entity to notify the persons affected?  No.

Are there circumstances under which a refusal clause may not be exercised?  No.

Does the law require the refusing individual or entity to provide medically and factually accurate information or provide a referral for abortion services?  No.

Does the law provide a mechanism for women to otherwise obtain specific reproductive-health services, information, or referrals if an individual and/or entity exercises a refusal clause?  No.

Haw. Rev. Stat. Ann. § 453-16 (Enacted 1970; Last Amended 2008).

HEALTH-CARE PROVIDER AND HEALTH-CARE INSTITUTIONS REFUSAL CLAUSE

Hawaii allows certain individuals or entities to refuse to comply with an individual health-care instruction or decision based on conscience.

To whom does the refusal clause apply?  Health-care providers and health-care institutions.

What does the refusal clause allow?  Health-care providers may decline to comply with an individual instruction or health-care decision based on conscience.  A health-care institution may decline to comply with an individual instruction or health-care decision if contrary to a policy of the institution which is expressly based on conscience.

Does the law require the refusing individual or entity to notify the persons affected?  Yes.  A health-care provider or health-care institution that refuses to comply with an individual health-care instruction or health-care decision must promptly inform the patient.

Are there circumstances under which a refusal clause may not be exercised?  No.

Does the law require the refusing individual or entity to provide medically and factually accurate information or provide a referral for the requested health services?  No.

Does the law provide a mechanism for women to otherwise obtain specific reproductive-health services, information, or referrals if an individual and/or entity exercises a refusal clause?  Yes.  A health-care provider or health-care institution that refuses to comply with an individual health-care instruction or health-care decision must (1) inform the patient promptly; (2) make all reasonable efforts to assist in the transfer of the patient to another health-care provider or institution that is willing to comply with the instruction or decision; and (3) provide continuing care to the patient until the transfer is accomplished or until it appears that a transfer cannot be accomplished.

Haw. Rev. Stat. Ann. § 327E-7 (Enacted 1999).

INSURANCE COVERAGE FOR CONTRACEPTION REFUSAL CLAUSE

Although Hawaii law requires health-insurance plans that cover prescription medication to provide equitable coverage for contraception, certain employers and/or insurers may require that their plans exclude coverage for contraception.

To whom does the refusal clause apply?  Religious employers for whom contraceptive services and supplies are contrary to their religious tenets.

What does the refusal clause allow?  A religious employer may require issuers of its health-insurance plans to exclude coverage of contraceptive services and supplies.

Does the law require the refusing entity to notify the persons affected?  Yes.  An employer exercising a refusal clause must: (1) provide written notice to enrollees upon enrollment in the health plan, listing the contraceptive services the employer refuses to cover for religious reasons; and (2) provide prompt written information describing how to access contraception.

Are there circumstances under which a refusal clause may not be exercised?  Yes.  A refusal clause may not be used to exclude coverage for prescription contraception ordered for reasons other than contraceptive purposes, such as decreasing the risk of ovarian cancer or eliminating the symptoms of menopause, or for prescription contraception necessary to preserve the life or health of an enrollee.

Does the law provide a mechanism for women to obtain contraceptive coverage if their employer exercises a refusal clause?  Yes.  Enrollees in an exempted health plan may purchase contraceptive coverage directly from the insurer, and the cost of purchasing such coverage shall not exceed the enrollee's pro-rata share of the price the group purchaser would have paid had the employer not invoked the religious exemption.

Is this refusal clause overbroad, jeopardizing insurance coverage for contraception for women?   Yes.  The law exempts a "religious employer" defined as a non-profit organization that has the purpose of inculcation of religious values, primarily employs persons who share the religious tenets of the entity, and is not staffed by public employees, as well as any educational, health-care, or other non-profit institution or organization owned or controlled by a religious employer.  This broad refusal clause inappropriately includes entities that operate in the public sphere.

Haw. Rev. Stat. Ann. §§ 431:10A-116.6 (Enacted 1993; Last Amended 2003), -116.7 (Enacted 1999; Last Amended 2003), 432:1-604.5 (Enacted 1993; Last Amended 1999).


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