SB2173

SECTION 1. The legislature finds that functional oral health is essential to overall health, nutrition, speech, social participation, and workforce readiness. The legislature further finds that severe tooth loss and oral dysfunction significantly impair an individual's ability to chew, eat, and maintain adequate nutrition, and are associated with poorer general health outcomes. The legislature believes that access to medically necessary dental reconstruction, specifically full‑arch dental implants, is a matter of health equity and public health.

Accordingly, the purpose of this Act is to require health insurers, mutual benefit societies, and health maintenance organizations that provide embedded dental insurance plans to provide coverage for full-arch dental implants.

SECTION 2. Chapter 431, Hawaii Revised Statutes, is amended by adding a new section to article 10A to be appropriately designated and to read as follows:

"§431:10A- Full-arch dental implants; benefits and coverage; notice. (a) Each individual and group accident and health or sickness insurance policy, contract, plan, or agreement issued or renewed in this State after December 31, , shall provide to the policyholder and individuals covered under the policy, contract, plan, or agreement, coverage for medically necessary full-arch dental implants and related services. Coverage required by this section shall be paid for by medical insurance.

(b) Every insurer shall provide notice to its policyholders regarding the coverage required by this section. The notice shall be in writing and prominently positioned in any literature or correspondence sent to policyholders and shall be transmitted to policyholders within calendar year when annual information is made available to policyholders or in any other mailing to policyholders, but in no case later than December 31, .

(c) Coverage provided under this section shall be subject to a maximum benefit of $ per treatment phase, but shall not be subject to limits on the number of visits to a dentist. After December 31, , the insurance commissioner, on an annual basis, shall adjust the maximum benefit for inflation using the medical care component of the United States Department of Labor Consumer Price Index for all urban consumers. The commissioner shall publish the adjusted maximum benefit annually no later than April 1 of each calendar year, which shall apply during the following calendar year to accident and health or sickness insurance policies, contracts, plans, or agreements subject to this section. Payments made by an insurer on behalf of a covered individual for any care, treatment, intervention, service, or item, the provision of which was for the treatment of a condition unrelated to the covered individual's full-arch dental implants, shall not be applied toward any maximum benefit established under this subsection.

(d) Coverage under this section may be subject to copayment, deductible, and coinsurance provisions of an accident and health or sickness insurance policy, contract, plan, or agreement that are no less favorable than the copayment, deductible, and coinsurance provisions for other medical services covered by the policy, contract, plan, or agreement.

(e) This section shall not be construed as limiting benefits that are otherwise available to an individual under an accident and health or sickness insurance policy, contract, plan, or agreement.

(f) This section shall not apply to limited benefit health insurance as provided pursuant to section 431:10A-607.

(g) For the purposes of this section, full-arch dental implants shall be considered medically necessary when a dentist who is licensed pursuant to chapter 448 and treating the individual determines that full-arch dental implants are medically necessary and other functional alternatives for prosthetic replacement, including dentures or removable prostheses, will not correct the individual's dental condition. Placement of full-arch dental implants for cosmetic reasons or based on the preference of the individual shall not be deemed medically necessary."

SECTION 3. Chapter 432, Hawaii Revised Statutes, is amended by adding a new section to article 1 to be appropriately designated and to read as follows:

"§432:1-613 Full-arch dental implants; benefits and coverage; notice. (a) Notwithstanding any law to the contrary, each individual and group hospital or medical service plan contract issued or renewed in this State after December 31, , shall provide to the member and individuals covered under the plan contract coverage for coverage for medically necessary full-arch dental implants and related services. Coverage required by this section shall be paid for by medical insurance.

(b) Every mutual benefit society shall provide notice to its members regarding the coverage required by this section. The notice shall be in writing and prominently positioned in any literature or correspondence sent to members and shall be transmitted to members within calendar year when annual information is made available to members or in any other mailing to members, but in no case later than December 31, .

(c) Coverage provided under this section shall be subject to a maximum benefit of $ per treatment phase but shall not be subject to any limits on the number of visits to a dentist. After December 31, , the insurance commissioner, on an annual basis, shall adjust the maximum benefit for inflation, using the medical care component of the United States Department of Labor Consumer Price Index for all urban consumers. The commissioner shall publish the adjusted maximum benefit annually no later than April 1 of each calendar year, which shall apply during the following calendar year to the plan contracts subject to this section. Payments made by a mutual benefit society on behalf of a covered individual for any care, treatment, intervention, service, or item, the provision of which was for the treatment of a condition unrelated to the covered individual's full-arch dental implants, shall not be applied toward any maximum benefit established under this subsection.

(d) Coverage under this section shall be subject to copayment, deductible, and coinsurance provisions of a plan contract to the extent that other medical services covered by the plan contract are subject to these provisions.

(e) This section shall not be construed as limiting benefits that are otherwise available to an individual under a plan contract.

(f) This section shall not apply to limited benefit health insurance as provided pursuant to section 431:10A-607.

SECTION 4. Section 432D-23, Hawaii Revised Statutes, is amended to read as follows:

"§432D-23 Required provisions and benefits. Notwithstanding any provision of law to the contrary, each policy, contract, plan, or agreement issued in the State after January 1, 1995, by health maintenance organizations pursuant to this chapter, shall include benefits provided in sections 431:10-212, 431:10A-115, 431:10A-115.5, 431:10A-116, 431:10A‑116.2, 431:10A-116.5, 431:10A-116.6, 431:10A-119, 431:10A-120, 431:10A-121, 431:10A-122, 431:10A-125, 431:10A-126, 431:10A-132, 431:10A-133, 431:10A-134, 431:10A-140, and [~~431:10A-134,~~] 431:10A- , and chapter 431M."

SECTION 5. The benefit to be provided by health maintenance organizations corresponding to the benefit provided under section 431:10A- , Hawaii Revised Statutes, as contained in the amendment to section 432D-23, Hawaii Revised Statutes, in section 4 of this Act, shall take effect for all policies, contracts, plans, or agreements issued in the State after December 31, .

SECTION 6. Statutory material to be repealed is bracketed and stricken. New statutory material is underscored.

SECTION 7. This Act shall take effect upon its approval.

INTRODUCED BY:	_____________________________

THE SENATE	S.B. NO.	2173
THIRTY-THIRD LEGISLATURE, 2026
STATE OF HAWAII