General information, not insurance advice or legal advice. This page explains Hawaii’s employer health-insurance law using published sources. It is not advice about your specific job or coverage. Confirm your rights with the Hawaii Department of Labor and Industrial Relations (DLIR), Disability Compensation Division, or a licensed insurance agent.
Last verified: 12 November 2026.
The short answer
Hawaii is the only state that requires nearly every employer to provide health insurance. Under the Prepaid Health Care Act (HRS Chapter 393, passed in 1974), your employer must offer you coverage if you work 20 or more hours a week for 4 straight weeks and earn at least $1,386.72 a month (in 2026).
Your employer must pay at least half the premium. Your share cannot be more than the smaller of 50% of the premium or 1.5% of your monthly gross wages.
The result: 97% of Hawaii employers offer health coverage — the highest rate of any state.
What the law is
The Prepaid Health Care Act was enacted in 1974 — about 40 years before the Affordable Care Act. It requires nearly every private employer in Hawaii, regardless of size — even a business with one employee — to provide health coverage to qualifying workers.
Congress carved out an explicit ERISA exemption in 1983 (29 U.S.C. § 1144(b)(5)) so the mandate could survive federal preemption. The exemption is frozen at the Act’s 1974 scope — Hawaii cannot expand the law without losing the exemption.
Who must be covered
You qualify for employer coverage when both of these are true:
- You work 20 or more hours per week for 4 consecutive weeks.
- You earn at least 86.67 times Hawaii’s minimum hourly wage per month. With the minimum wage at $16.00 an hour (January 1, 2026), the monthly earnings floor is $1,386.72.
Compare that to the federal ACA employer mandate, which only reaches employers with 50 or more full-time-equivalent employees, at 30 hours a week. Hawaii’s law reaches far more workers — including part-timers and employees of very small businesses.
Multiple jobs: if you work for more than one employer, you designate one “principal employer” who is responsible for your coverage.
What the employer must pay
- The employer must pay at least 50% of the premium.
- Your share may not exceed the smaller of 50% of the premium or 1.5% of your monthly gross wages.
- Example: an employee earning $65,000 a year ($5,417 a month gross) pays at most $81.25 a month for single coverage. The employer covers the rest — typically $520–$680 a month total for standard Silver- or Gold-equivalent PPO coverage (per livinginhawaii.com; approximate).
- The health plan must be certified by the Hawaii Department of Labor and Industrial Relations (DLIR), Disability Compensation Division, which enforces the Act.
The typical employee share for an employer plan is about $140–$240 a month (approximate, per howtoliveinhawaii.com).
The result
Hawaii’s employer offer rate is 97% — the highest of any state (AHIP analysis, July 20, 2026). Washington, D.C. is second at 93% and Massachusetts third at 90%. Hawaii’s uninsured rate is about 3–4%, among the lowest in the country.
Hawaii is also the only state that requires both an employer health mandate and a Temporary Disability Insurance (TDI) program (HRS Chapter 392, in effect since 1969), which replaces part of your wages if you cannot work because of a non-work-related illness or injury.
What this means for you
If you are an employee
- Once you hit 20 hours a week for 4 straight weeks and the wage floor, your employer must enroll you. If your employer has not offered coverage, ask your HR department first — then contact the DLIR Disability Compensation Division, which enforces the Act.
- Your share of the premium is capped by law at 1.5% of your monthly gross wages (or 50% of the premium, whichever is less). If you are being charged more, that is worth checking with DLIR.
- If you leave the job or your hours drop below 20 a week, you may lose the employer plan. Losing job-based coverage opens a Special Enrollment Period on HealthCare.gov, and you may qualify for Med-QUEST if your income is low.
If you are a small employer
- The law applies to you even if you have one employee. You must offer a DLIR-certified plan to any worker who meets the 20-hour and wage tests, and pay at least half the premium.
- HMSA, Kaiser, and UHA all sell employer group plans in Hawaii. UHA offers group plans only — no individual plans — and serves groups of all sizes.
- The federal ACA mandate (50+ full-time-equivalent employees) is separate and does not replace the Hawaii law.
FAQ
I work 15 hours a week. Am I covered?
No — the mandate only applies at 20 or more hours a week for 4 consecutive weeks. If you work fewer hours, your employer is not required to offer you coverage. Check the marketplace at HealthCare.gov for a plan (premium tax credits may help), or Med-QUEST if your income qualifies.
Does the law apply to part-time workers?
Yes, if you meet the test: 20 or more hours a week for 4 straight weeks and earnings of at least $1,386.72 a month in 2026. Part-time workers who meet the test have the same right to coverage as full-time workers.
My employer says the plan costs too much. What can I do?
Your share of the premium is capped by law — no more than 1.5% of your monthly gross wages or 50% of the premium, whichever is less. If your employer is charging more than the cap, or not offering coverage at all when you qualify, contact the DLIR Disability Compensation Division, which enforces the Prepaid Health Care Act. You can also compare your options on HealthCare.gov or check Med-QUEST eligibility.
Sources
- Hawaii Department of Labor and Industrial Relations, Prepaid Health Care Act information (HRS Chapter 393) — via legalclarity.org and statewagetools.com
- Hawaii Revised Statutes, Chapter 393 (Prepaid Health Care Act)
- AHIP, July 20, 2026 analysis (97% employer offer rate) — via liveinsurancenews.com
- UHA Health Insurance, employer forms — http://www.uhahealth.com/faqs
- howtoliveinhawaii.com, “Cost of Healthcare in Hawaii” (updated Oct–Nov 2026)
- livinginhawaii.com (employer premium example)
This page describes the law in general terms. If you believe your employer is not following it, contact the DLIR Disability Compensation Division for help with your specific situation.