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Key to Health Plan Terms and Acronyms
Largest Private Health Plans:
The total market consists of the total number of lives covered by insurance whether from private or public sources. In 2004, HMSA and Kaiser Permanente continued in their market positions as the largest private health plans in Hawai'i, with 42 percent and 13 percent of the market, respectively.
Employment-Based Coverage:
According to U.S. Census figures, of the people covered by private health plans in Hawai'i, 93 percent were covered through employment-based plans in 2004. This is up from 82 percent in 1990.1
Overlapping Coverage:
One in six Hawai'i residents was covered by more than one health plan in 2004.
Government Programs:
Overall, the number of covered lives in government sponsored plans have remained stable since 1992. Medicare, the federal government's coverage for the elderly, accounted for 8 percent of the covered lives in 2004; QUEST and Medicaid, state and federally-funded programs, held 11 percent and 3 percent respectively; and TRICARE, the federal government's coverage for military-dependent and military retiree health care, accounted for 10 percent. In total, government programs represent 36.5 percent of the covered lives.
QUEST Plans:
HMSA has the largest QUEST plan with 6.1 percent of all Hawai'i covered lives. AlohaCare is the second largest with 3.5 percent of all covered lives. Overall, QUEST enrollment declined between 1995 and 2004 by 11 percent, although enrollment has slowly increased since 1999. Current QUEST enrollment rates are 11.1 percent of covered lives. The decline in enrollment around the mid to late 1990s was primarily due to changes in eligibility requirements in 1996, including caps on the number of lives covered. HMSA's QUEST plan experienced a low enrollment of 2.5 percent of total covered lives in 2000, but has since regained its membership due to changes in the state's enrollment cap policies and the reduced number of participating plans.
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Source: Hawaii Management Alliance Association.; Hawaii Medical Service Association.; Kaiser Permanente.; MDX Hawaii.; University Health Alliance.; Health Trends in Hawai`i, eds. 1-6.
Note: Covered lives are the individuals "covered" by a health plan. 2003 Medicare and Medicare (FFS) covered lives are assumed for 2004.
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Source: AlohaCare.; Hawaii Medical Service Association.; Kaiser Permanente.; TriWest.; Hawai`i State Department of Human Services, MedQUEST Division.; Health Trends in Hawai`i, eds. 1-6.; Centers for Medicare and Medicaid Services.
Note: Covered lives are the individuals "covered" by a health plan. 2003 Medicare and Medicare (FFS) covered lives are assumed for 2004. Government coverage includes any plan funded by the government.
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Source: AlohaCare.; Hawaii Medical Service Association.; Kaiser Permanente.; Hawai`i State Department of Human Services, MedQUEST Division.; Health Trends in Hawai`i, eds. 1-6.
Note: Covered lives are the individuals "covered" by a health plan. 2003 Medicare and Medicare (FFS) covered lives are assumed for 2004. Prior to 2002, "Other" includes QUEST-eligible individuals covered by Queen's Hawai`i Care, Kapi`olani Health Hawai`i, and StraubCare Quanatum. These plans went out of existence in 2002, thus the decrease in "Other" and the increase in the other plans that absorbed QUEST-eligible individuals. From 2002 on, "Other" includes QUEST-eligible individuals who are not covered by any of the three existing insurers.
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Source: AlohaCare.; Hawaii Management Alliance Association.; Hawaii Medical Service Association.; Kaiser Permanente.; MDX Hawaii.; University Health Alliance.; Hawai`i State Department of Human Services, MedQUEST Division.; Health Trends in Hawai`i, eds. 1-6.; Centers for Medicare and Medicaid Services.; U.S. Census Bureau.
Note: Covered lives are the individuals "covered" by a health plan. 2003 Medicare and Medicare (FFS) covered lives are assumed for 2004. Net residential population excludes the military. Government coverage includes any plan funded by the government; excludes military coverage.
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