Hawaii employees are covered by the HMSA PPO plan for Medical, Dental, Vision, Life and Accidental Death & Dismemberment (AD&D) benefits. Learn more about these benefits below, or at HMSA.com. This plan is available only to residents of Hawaii.
Medical benefits for employees in Hawaii are provided by the Hawaii HMSA PPO Plan. This plan is only available to residents of Hawaii.
Hawaii HMSA PPO Plan | ||
---|---|---|
In-Network | Out-of-Network | |
Annual Deductible | ||
Employee Only | $0 | $100 |
Family | $0 | $300 maximum ($100 per person) |
Coinsurance (after deductible) | ||
Inpatient (most services) | You pay 10% | You pay 30% |
Outpatient (most services) | You pay 20% | You pay 30% |
Annual Out-of-Pocket Maximum | ||
Employee Only | $2,500 | $2,500 |
Family | $7,500 | $7,500 |
Preventive Care |
You pay $0 | You pay 30% |
Office Visit | ||
Primary Care Physician | $12 copay | You pay 30% |
Specialist | $12 copay | You pay 30% |
Urgent Care | $12 copay | You pay 30% |
Emergency Room (true emergency) | You pay 20% | You pay 20% |
Annual Prescription Out-of-Pocket Maximum | ||
Employee Only | $3,600 | $3,600 |
Family | $4,200 | $4,200 |
Pharmacy (1-30 day supply) | ||
Tier 1 (Generic) | $7 copay | $7 copay plus 20%* |
Tier 2 (Preferred Brand) | $30 copay | $30 copay plus 20%* |
Tier 3 (Non-Preferred Brand) | $30 copay plus $45** | $30 copay plus 20%* |
Tier 4 (Preferred Specialty) | $100 copay | Not covered |
Tier 5 (Non-Preferred Specialty) | $200 copay | Not covered |
Mail Order (84-90 day supply) | ||
Tier 1 (Generic) | $11 copay | Not covered |
Tier 2 (Preferred Brand) | $65 copay | Not covered |
Tier 3 (Non-Preferred Brand) | $65 copay plus $135** | Not covered |
Tier 4 (Preferred Specialty) | Not covered | Not covered |
Tier 5 (Non-Preferred Specialty) | Not covered | Not covered |
Visit hmsa.com to access your suite of well-being tools and to log in to your My Account profile to view in-depth information about your health plan.
* 20% coinsurance/prescription; deductible does not apply.
**Tier 3 cost share
Click here for machine-readable files (MRFs) listing in-network rates and out-of-network allowed amounts.
Employee premiums for medical coverage are based on the coverage level you select.
Hawaii HMSA PPO Plan Premiums | |
---|---|
Employee Only | $24.50 |
Employee + Child(ren) | $90.00 |
Employee + Spouse/Domestic Partner | $114.00 |
Family | $158.00 |
Hawaii employees who are enrolled in the HMSA medical plan will receive vision benefits through the same plan.
HMSA Vision Plan | ||
---|---|---|
Plan Features | Adult | Child |
Vision Exam (once per calendar year) |
$10 copay | $10 copay |
Eyeglasses | ||
Lenses (once per calendar year) |
$10 copay | $10 copay |
Frames (once per 24 months) |
$15 copay | $15 copay |
Contact Lenses (in lieu of lenses and frames) (once per calendar year)Contact Lens Fitting (once per calendar year) |
$25 copay (up to $130 allowance) Charges over $45 plan payment |
50% of eligible charge |
Hawaii employees who are enrolled in the HMSA medical plan will receive dental benefits through the same plan.
HMSA Dental Plan | |
---|---|
In-Network | |
Plan Features | You pay: |
Annual Benefit Maximum | $1,500 |
Rollover Amount | Up to $500 (max accumulation $1,250) |
Diagnostic and Preventive Services
|
covered in full |
Basic and Restorative Services
|
30% |
Major Services after 12-month waiting period
|
50% |
Orthodontia | Not covered |
*Enhanced Dental Benefits: Certain medical conditions are eligible for additional dental services and support. Find out more about covered conditions at www.hmsa.com/oralhealth.
Hawaii employees who are enrolled in the HMSA medical plan will receive Life and Accidental Death and Dismemberment (AD&D) insurance benefits through the same plan.
HMSA Life and AD&D Insurance | |
---|---|
Benefit | Coverage Amount |
Life Insurance | $30,000 benefit per eligible subscriber |
Accidental Death & Dismemberment | $30,000 benefit per eligible subscriber |
Accelerated Death Benefit | $15,000 benefit per eligible subscriber |
Temporary Disability Insurance (TDI) coverage is available only to employees in Hawaii who meet the eligibility requirements outlined in the policy. It is designed to provide income for you and your family in the event of a temporary disability. After you’ve been out of work for seven calendar days and have been deemed unable to work by a qualified physician, temporary disability insurance begins to cover 58% of your average weekly earnings. These benefits last for up to 26 weeks, including the seven calendar day waiting period. Genesys pays the full cost of this benefit.
Temporary Disability Insurance (TDI) | |
---|---|
Benefits Begin | on the 8th day of injury or illness |
Benefit Amount | 58% of average weekly earnings (up to 26 weeks) |