HMSA Plan (Hawaii Employees)

PARTNER | Hawaii Medical Service Association (HMSA)

PPO Preferred Provider Organization

California Times offers employees in Hawaii a PPO (Preferred Provider Organization) through Hawaii Medical Service Association (HMSA). This plan includes Dental and Vision coverage , and has a robust network of providers and a number of member service tools to help you navigate the healthcare marketplace. The plan shares costs with members using coinsurance for most benefits and set copays for others.

HMSA (Hawaii Medical Service Association)

(808) 948-5555

hmsa.com

Hawaii Medical Service Association (HMSA) Network: HMSA Network
Group/Policy #: 32237-1-6

  • Deductible | $0 The amount you owe for health care services before your health insurance or plan begins to pay.
  • Maximum Out of Pocket- Medical | $2,500 Individual ($7,500 Family) The money you pay for covered medical and pharmacy services counts toward your out of pocket maximum. Once you meet your designated out of pocket maximum, the plan will pay for all of your covered healthcare costs for the rest of the plan year.
  • Maximum Out of Pocket - Pharmacy | $3,600 Individual ($4,200 Family) The money you pay for covered medical and pharmacy services counts toward your out of pocket maximum. Once you meet your designated out of pocket maximum, the plan will pay for all of your covered healthcare costs for the rest of the plan year.
  • Primary Care Doctor | $12 per visit A PCP is the person your child should see for a routine checkup or non-emergency medical care
  • Specialist | $12 copay per visit A physician specialist focuses on a specific area of medicine or a group of patients to diagnose, manage, prevent or treat a certain types of symptoms and conditions
  • Telemedicine | $12 copay Telemedicine refers to the practice of caring for patients remotely when the provider and patient are not physically present with each other. Modern technology has enabled doctors to consult patients by using HIPAA compliant video-conferencing tools.
  • Urgent Care | $12 copay Care for an illness, injury or condition serious enough that a reasonable person would seek care right away, but not so severe as to require emergency room care.
  • Hospital | $12 copay + 10% The portion of eligible expenses that plan members are responsible paying, most often after the deductible is met. It's usually determined as a percentage of the total cost.
  • X-Ray and Labs | 20% coinsurance The portion of eligible expenses that plan members are responsible paying, most often after the deductible is met. It's usually determined as a percentage of the total cost.
  • Emergency Room | $12 copay + 20% The Emergency Room (ER) provides care for these critical or life-threatening conditions and not for routine health care.

*Plan Design Shown Above represent In-Network Benefits

RESOURCE LIBRARY

EDUCATIONAL VIDEOS