Medical Insurance: Hawaii

Employees in Hawaii have the option of enrolling in one of four medical plans offered by HMSA and Kaiser.  The following options are available:

HMSA

HMSA Preferred Provider Plan  (PPP B)

(80/20 – HMSA pays 80% for most services, individual pays 20%)

May obtain services from any HMSA preferred provider.

Maximum Annual copay: $3,000/person; $9,000/family

Deductible (Calendar): $300/person; $900/family

Outpatient Lab/Xray copay: 20%

Physician Visits: $17 copay

Emergency Room: 20% coinsurance

Chiropractor/Acupuncture/Massage: $20 Copay,12 visits max. Prescription required for massage.

HMSA Health Plan Hawaii Plus (HPH B)

Must choose Health Plan Center & Primary Care Provider from HMSA network. Must be referred by Primary Care Provider to obtain services from other health providers.

Maximum Annual copay: $2,500/person; $7,500/family

Physician Visits: $20 copay

Urgent Care Visits: $20 copay

Emergency Room Services:  20% coinsurance

Outpatient Hospital: 20% coinsurance

Chiropractor/Acupuncture/Massage: $20 copay,12 visits max. Prescription required for massage.

KAISER

Kaiser Added Choice

(80/20 Plan – for most services from out of-network provider, Kaiser pays 80% and individual pays 20%, after meeting deductible)

Services provided at Kaiser Facility or by in-network doctor

For services at Kaiser Facility – See below (Kaiser HMO)

In-Network and Out-of-Network Benefits

Maximum Annual copay(out of pocket):$2,000/person; $6,000/family

Physician visits: $20 copay

Emergency Room: $100 copay per visit, in and out of covered service area

Annual deductible: $100/person; $300/family

Inpatient Hospital: 10% coinsurance

Rx: $5 copay Generic maintenance Rx OTC/ $10 copay Other generic/ $45 copay Brand Rx

Chiropractor/Acupuncture/Massage: $20 Copay, 12 visits max. Prescription may be required.

Kaiser HMO

Services provided at Kaiser Facility only

Maximum Annual Copay(out of pocket):$2,500/person;  $7,500/family

Physician visits: $20 copay

Emergency Room: $100 copay per visit, in and out of covered service areas

Inpatient Hospital: 10% coinsurance

Specialty Rx: $75 copay

Chiropractor/Acupuncture/Massage: $20 Copay,12 visits max. Prescription may be required.

Coverage for routine, continuing and follow-up primary care for out-of-state full time college students attending college outside of the Kaiser service area and within the U.S.

 

For plan options, premium rates, and detailed information, refer to the 2016 Benefits Guide.