Compare Plans

You deserve the freedom to choose what’s best for you, especially when it comes to your health. Explore our health plans below to find one that fits your needs.

  • Premiums are determined by your age and may be adjusted based on tobacco use.
  • All prices and benefits listed are for each individual looking for a plan.
  • All benefits are for services received from a participating provider.
  • All services are subject to the deductible unless noted.
  • PPO and HMO plans are different; make sure you choose what’s right for you.

2015 Plans

Our medical plans no longer include children’s dental benefits, but you can choose an HMSA pediatric dental plan to get covered.

Plan type Deductible Max out– of–pocket Coinsurance Doctor visit copayment Premiums
based on age:
Platinum PPO

Plan Details

Prescription drugs (30-day supply)
  • Generic: $7
  • Preferred: $30
  • Other brand name: $754
$0 $2,500 10% $20 $ 173.49 /month $ 273.22 /month $ 274.31 /month $ 279.77 /month $ 286.33 /month $ 296.99 /month $ 305.73 /month $ 310.10 /month $ 316.66 /month $ 323.22 /month $ 327.31 /month $ 331.69 /month $ 333.87 /month $ 336.06 /month $ 338.24 /month $ 340.43 /month $ 344.80 /month $ 349.17 /month $ 355.73 /month $ 362.01 /month $ 370.76 /month $ 381.68 /month $ 394.52 /month $ 409.83 /month $ 427.04 /month $ 446.71 /month $ 466.11 /month $ 487.97 /month $ 509.55 /month $ 533.32 /month $ 557.36 /month $ 583.32 /month $ 609.27 /month $ 637.41 /month $ 665.83 /month $ 696.16 /month $ 711.18 /month $ 741.51 /month $ 767.74 /month $ 784.95 /month $ 806.54 /month $ 819.65 /month
Platinum HMO

Plan Details

Prescription drugs (30-day supply)
  • Generic: $7
  • Preferred: $30
  • Other brand name: $754
$0 $2,500 10% $10 $ 169.25 /month $ 266.54 /month $ 266.54 /month $ 267.61 /month $ 272.94 /month $ 279.33 /month $ 289.73 /month $ 298.26 /month $ 302.52 /month $ 308.92 /month $ 315.32 /month $ 319.31 /month $ 323.58 /month $ 325.71 /month $ 327.84 /month $ 329.98 /month $ 332.11 /month $ 336.37 /month $ 340.64 /month $ 347.03 /month $ 353.16 /month $ 361.69 /month $ 372.35 /month $ 384.88 /month $ 399.81 /month $ 416.60 /month $ 435.79 /month $ 454.72 /month $ 476.04 /month $ 497.10 /month $ 520.28 /month $ 543.74 /month $ 569.06 /month $ 594.38 /month $ 621.84 /month $ 649.56 /month $ 679.14 /month $ 693.80 /month $ 723.39 /month $ 748.97 /month $ 765.77 /month $ 786.82 /month $ 799.62 /month
Gold PPO

Plan Details

Prescription drugs (30-day supply)
  • Generic: $7
  • Preferred: $30
  • Other brand name: $754
Additional benefits
$0 $6,600 30% $30 $ 141.41 /month $ 222.69 /month $ 223.58 /month $ 228.03 /month $ 233.38 /month $ 242.06 /month $ 249.19 /month $ 252.75 /month $ 258.09 /month $ 263.44 /month $ 266.78 /month $ 270.34 /month $ 272.12 /month $ 273.90 /month $ 275.69 /month $ 277.47 /month $ 281.03 /month $ 284.59 /month $ 289.94 /month $ 295.06 /month $ 302.19 /month $ 311.09 /month $ 321.56 /month $ 334.03 /month $ 348.06 /month $ 364.09 /month $ 379.90 /month $ 397.72 /month $ 415.31 /month $ 434.68 /month $ 454.28 /month $ 475.44 /month $ 496.59 /month $ 519.53 /month $ 542.69 /month $ 567.40 /month $ 579.65 /month $ 604.37 /month $ 625.75 /month $ 639.78 /month $ 657.37 /month $ 668.06 /month $ 668.06 /month
Gold PPO 1000

Plan Details

Prescription drugs (30-day supply)
  • Generic: $7
  • Preferred: $301
  • Other brand name: $751, 4
Additional benefits
$1,000 $4,000 20% $20 $ 131.84 /month $ 207.63 /month $ 208.46 /month $ 212.61 /month $ 217.59 /month $ 225.69 /month $ 232.33 /month $ 235.65 /month $ 240.64 /month $ 245.62 /month $ 248.74 /month $ 252.06 /month $ 253.72 /month $ 255.38 /month $ 257.04 /month $ 258.70 /month $ 262.02 /month $ 265.35 /month $ 270.33 /month $ 275.10 /month $ 281.75 /month $ 290.05 /month $ 299.81 /month $ 311.44 /month $ 324.52 /month $ 339.47 /month $ 354.21 /month $ 370.82 /month $ 387.22 /month $ 405.28 /month $ 423.56 /month $ 443.28 /month $ 463.00 /month $ 484.39 /month $ 505.98 /month $ 529.03 /month $ 540.45 /month $ 563.49 /month $ 583.43 /month $ 596.51 /month $ 612.91 /month $ 622.88 /month
Gold HMO

Plan Details

Prescription drugs (30-day supply)
  • Generic: $7
  • Preferred: $30
  • Other brand name: $751, 4
Additional benefits
$1,000 $4,000 20% $15 $ 131.84 /month $ 207.62 /month $ 208.45 /month $ 212.60 /month $ 217.58 /month $ 225.68 /month $ 232.32 /month $ 235.64 /month $ 240.63 /month $ 245.61 /month $ 248.72 /month $ 252.05 /month $ 253.71 /month $ 255.37 /month $ 257.03 /month $ 258.69 /month $ 262.01 /month $ 265.33 /month $ 270.32 /month $ 275.09 /month $ 281.73 /month $ 290.04 /month $ 299.80 /month $ 311.42 /month $ 324.50 /month $ 339.45 /month $ 354.19 /month $ 370.80 /month $ 387.20 /month $ 405.27 /month $ 423.54 /month $ 443.26 /month $ 462.98 /month $ 484.37 /month $ 505.96 /month $ 529.00 /month $ 540.42 /month $ 563.47 /month $ 583.40 /month $ 596.48 /month $ 612.88 /month $ 622.85 /month
Silver PPO 1200

Plan Details

Prescription drugs (30-day supply)
  • Generic: $10
  • Preferred: $50 1
  • Other brand name: $1001, 3
Additional benefits
$1,200 $6,600 40% $40 $ 109.88 /month $ 173.04 /month $ 173.74 /month $ 177.20 /month $ 181.35 /month $ 188.10 /month $ 193.64 /month $ 196.40 /month $ 200.56 /month $ 204.71 /month $ 207.31 /month $ 210.07 /month $ 211.46 /month $ 212.84 /month $ 214.23 /month $ 215.61 /month $ 218.38 /month $ 221.15 /month $ 225.30 /month $ 229.28 /month $ 234.82 /month $ 241.74 /month $ 249.87 /month $ 259.57 /month $ 270.47 /month $ 282.93 /month $ 295.21 /month $ 309.06 /month $ 322.73 /month $ 337.78 /month $ 353.01 /month $ 369.45 /month $ 385.89 /month $ 403.71 /month $ 421.71 /month $ 440.91 /month $ 450.43 /month $ 469.64 /month $ 486.25 /month $ 497.15 /month $ 510.82 /month $ 519.13 /month $ 519.13 /month
Silver PPO 2500

Plan Details

Prescription drugs (30-day supply)
  • Generic: $10
  • Preferred: $501
  • Other brand name: $1001, 3
Additional benefits
$2,500 $6,600 20% $30 $ 104.88 /month $ 165.16 /month $ 165.82 /month $ 169.12 /month $ 173.09 /month $ 179.53 /month $ 184.1 /month $ 187.45 /month $ 191.42 /month $ 195.38 /month $ 197.86 /month $ 200.50 /month $ 201.82 /month $ 203.14 /month $ 204.47 /month $ 205.79 /month $ 208.43 /month $ 211.07 /month $ 215.04 /month $ 218.83 /month $ 224.12 /month $ 230.73 /month $ 238.49 /month $ 247.74 /month $ 258.14 /month $ 270.03 /month $ 281.76 /month $ 294.97 /month $ 308.02 /month $ 322.39 /month $ 336.92 /month $ 352.61 /month $ 368.30 /month $ 385.31 /month $ 402.49 /month $ 420.82 /month $ 429.91 /month $ 448.24 /month $ 464.09 /month $ 474.50 /month $ 487.54 /month $ 495.47 /month
Silver HMO

Plan Details

Prescription drugs (30-day supply)
  • Generic: $10
  • Preferred: $501
  • Other brand name: $1001, 3
Additional benefits
$2,500 $6,600 30% $20 $ 101.00 /month $ 159.06 /month $ 159.70 /month $ 162.88 /month $ 166.69 /month $ 172.90 /month $ 177.99 /month $ 180.53 /month $ 184.35 /month $ 188.17 /month $ 190.55 /month $ 193.10 /month $ 194.37 /month $ 195.64 /month $ 196.92 /month $ 198.19 /month $ 200.73 /month $ 203.28 /month $ 207.10 /month $ 210.75 /month $ 215.84 /month $ 222.21 /month $ 229.68 /month $ 238.59 /month $ 248.61 /month $ 260.06 /month $ 271.36 /month $ 284.08 /month $ 296.65 /month $ 310.48 /month $ 324.48 /month $ 339.59 /month $ 354.70 /month $ 371.09 /month $ 387.63 /month $ 405.28 /month $ 414.03 /month $ 431.69 /month $ 446.96 /month $ 456.98 /month $ 469.54 /month $ 477.18 /month
Bronze PPO 6600

Plan Details

Prescription drugs (30-day supply)
  • Generic: $10
  • Preferred: $01
  • Other brand name: $01
Additional benefits

Fitness membership
(With $75 annual copayment)
Must be at least 16 years of age to participate.

$6,600 $6,600 0% $0 $ 82.67 /month $ 130.19 /month $ 130.71 /month $ 133.32 /month $ 136.44 /month $ 141.52 /month $ 145.69 /month $ 147.77 /month $ 150.89 /month $ 154.02 /month $ 155.97 /month $ 158.05 /month $ 159.10 /month $ 160.14 /month $ 161.18 /month $ 162.22 /month $ 164.30 /month $ 166.39 /month $ 169.51 /month $ 172.51 /month $ 176.67 /month $ 181.88 /month $ 188.00 /month $ 195.29 /month $ 203.49 /month $ 212.86 /month $ 222.11 /month $ 232.52 /month $ 242.81 /month $ 254.14 /month $ 265.59 /month $ 277.96 /month $ 290.33 /month $ 303.74 /month $ 317.28 /month $ 331.73 /month $ 338.89 /month $ 353.34 /month $ 365.84 /month $ 374.04 /month $ 384.33 /month $ 390.58 /month
Bronze HMO

Plan Details

Prescription drugs (30-day supply)
  • Generic: $10
  • Preferred: $501
  • Other brand name: $1001, 3
Additional benefits

Fitness membership
(With $75 annual copayment)
Must be at least 16 years of age to participate.

$5,000 $6,600 10% $30 $ 87.13 /month $ 137.22 /month $ 137.77 /month $ 140.51 /month $ 143.80 /month $ 149.16 /month $ 153.55 /month $ 155.74 /month $ 159.04 /month $ 162.33 /month $ 164.39 /month $ 166.58 /month $ 167.68 /month $ 168.78 /month $ 169.88 /month $ 170.97 /month $ 173.17 /month $ 175.36 /month $ 178.66 /month $ 181.81 /month $ 186.20 /month $ 191.69 /month $ 198.14 /month $ 205.83 /month $ 214.47 /month $ 224.35 /month $ 234.09 /month $ 245.07 /month $ 255.91 /month $ 267.85 /month $ 279.92 /month $ 292.96 /month $ 306.00 /month $ 320.13 /month $ 334.40 /month $ 349.63 /month $ 357.18 /month $ 372.41 /month $ 385.58 /month $ 394.23 /month $ 405.07 /month $ 411.65 /month
Catastrophic Plan

This is single coverage for individuals under 30 years of age OR have a hardship exemption from the Hawaii Health Connector.

Plan Details

Prescription drugs (30-day supply)
  • Generic: $01
  • Preferred: $01
  • Other brand name: $01
Additional benefits
$6,600 $6,600 0% $502 $ 77.03 /month $ 121.31 /month $ 121.79 /month $ 124.22 /month $ 127.13 /month $ 131.86 /month $ 135.74 /month $ 137.68 /month $ 140.59 /month $ 143.51 /month $ 145.32 /month $ 147.27 /month $ 148.24 /month $ 149.21 /month $ 150.18 /month $ 151.15 /month $ 153.09 /month $ 155.03 /month $ 157.94 /month $ 160.73 /month $ 164.61 /month $ 169.46 /month $ 175.17 /month $ 181.96 /month $ 189.60 /month $ 198.34 /month $ 206.95 /month $ 216.65 /month $ 226.24 /month $ 236.79 /month $ 247.46 /month $ 258.99 /month $ 270.51 /month $ 283.01 /month $ 295.62 /month $ 309.09 /month $ 315.76 /month $ 329.23 /month $ 340.87 /month $ 348.51 /month $ 358.10 /month $ 363.92 /month
  1. Member’s cost after the deductible is met.
  2. First three visits are covered before you reach the deductible.
  3. $50 copayment plus $50 other brand name cost share.
  4. $30 copayment plus $45 other brand cost share.

Health benefits
These benefits are included in all HMSA individual plans, and many are available as soon as you enroll:
  • HMSA’s Online Care.
  • An annual physical/wellness exam with no copayment.
  • Generic drug coverage*.
  • Adult vision coverage.

*Generic drugs are covered before you meet the deductible, except for single source generic drugs (drugs manufactured by a single pharmaceutical company) dispensed at a pharmacy.

Health benefits

Dental benefits

2014 Plans

See the difference between HMO and PPO and choose what’s right for you.

Plan type Deductible Max out– of–pocket Coinsurance Doctor visit copayment Premiums
based on age:
Platinum PPO 100

Plan Details

Prescription drugs (30-day supply)
  • Generic: $7
  • Preferred: $30
  • Other brand name: $75
    ($30 copayment plus $45 other brand name cost share)
Additional benefits

Chiropractor, acupuncture, and massage therapy benefit of up to 12 visits annually.
The copayment is $20.

$100 $2,000 10% $20 $ 184.41 /month $ 290.42 /month $ 290.42 /month $ 290.42 /month $ 290.42 /month $ 291.58 /month $ 297.39 /month $ 304.35 /month $ 315.68 /month $ 324.98 /month $ 329.62 /month $ 336.59 /month $ 343.56 /month $ 347.92 /month $ 352.56 /month $ 354.89 /month $ 357.21 /month $ 359.53 /month $ 361.86 /month $ 366.51 /month $ 371.15 /month $ 378.13 /month $ 384.80 /month $ 394.09 /month $ 405.71 /month $ 419.36 /month $ 435.62 /month $ 453.92 /month $ 474.83 /month $ 495.45 /month $ 518.68 /month $ 541.63 /month $ 566.89 /month $ 592.45 /month $ 620.04 /month $ 647.62 /month $ 677.54 /month $ 707.75 /month $ 739.98 /month $ 755.95 /month $ 788.19 /month $ 816.07 /month $ 834.36 /month $ 857.30 /month $ 871.25 /month $ 871.25 /month
Platinum PPO 100 with Children’s Dental

Plan Details

Prescription drugs (30-day supply)
  • Generic: $7
  • Preferred: $30
  • Other brand name: $75
    ($30 copayment plus $45 other brand name cost share)
Additional benefits

Chiropractor, acupuncture, and massage therapy benefit of up to 12 visits annually.
The copayment is $20.

$ 100 $2,000 10% $20 $ 184.94 /month $ 291.24 /month $ 291.24 /month $ 291.24 /month $ 291.24 /month $ 292.40 /month $ 298.23 /month $ 305.22 /month $ 316.57 /month $ 325.89 /month $ 330.56 /month $ 337.54 /month $ 344.53 /month $ 348.91 /month $ 353.56 /month $ 355.89 /month $ 358.22 /month $ 360.56 /month $ 362.88 /month $ 367.54 /month $ 372.20 /month $ 379.19 /month $ 385.88 /month $ 395.21 /month $ 406.86 /month $ 420.55 /month $ 436.86 /month $ 455.20 /month $ 476.17 /month $ 496.85 /month $ 520.15 /month $ 543.16 /month $ 568.50 /month $ 594.12 /month $ 621.79 /month $ 649.46 /month $ 679.45 /month $ 709.75 /month $ 742.07 /month $ 758.09 /month $ 790.42 /month $ 818.37 /month $ 836.73 /month $ 859.73 /month $ 873.71 /month $ 873.71 /month
Platinum HMO

Plan Details

Prescription drugs (30-day supply)
  • Generic: $7
  • Preferred: $30
  • Other brand name: $75
    ($30 copayment plus $45 other brand name cost share)
Additional benefits

Chiropractor, acupuncture, and massage therapy benefit of up to 12 visits annually.
The copayment is $20.

$ 100 $2,000 10% $20 $ 180.65 /month $ 284.49 /month $ 284.49 /month $ 284.49 /month $ 284.49 /month $ 285.63 /month $ 291.31 /month $ 298.15 /month $ 309.24 /month $ 318.35 /month $ 322.90 /month $ 329.72 /month $ 336.55 /month $ 340.82 /month $ 345.37 /month $ 347.65 /month $ 349.92 /month $ 352.20 /month $ 354.47 /month $ 359.02 /month $ 363.58 /month $ 370.41 /month $ 376.95 /month $ 386.05 /month $ 397.43 /month $ 410.81 /month $ 426.73 /month $ 444.66 /month $ 465.14 /month $ 485.34 /month $ 508.10 /month $ 530.58 /month $ 555.33 /month $ 580.36 /month $ 607.39 /month $ 634.41 /month $ 663.71 /month $ 693.30 /month $ 724.88 /month $ 740.53 /month $ 772.10 /month $ 799.41 /month $ 817.34 /month $ 839.81 /month $ 853.46 /month $ 853.46 /month
Platinum HMO with Children’s Dental

Plan Details

Prescription drugs (30-day supply)
  • Generic: $7
  • Preferred: $30
  • Other brand name: $75
    ($30 copayment plus $45 other brand name cost share)
Additional benefits

Chiropractor, acupuncture, and massage therapy benefit of up to 12 visits annually.
The copayment is $20.

$100 $2,000 10% $20 $ 181.17 /month $ 285.31 /month $ 285.31 /month $ 285.31 /month $ 285.31 /month $ 286.45 /month $ 292.16 /month $ 299.01 /month $ 310.13 /month $ 319.26 /month $ 323.83 /month $ 330.68 /month $ 337.52 /month $ 341.81 /month $ 346.37 /month $ 348.65 /month $ 350.94 /month $ 353.21 /month $ 355.50 /month $ 360.07 /month $ 364.63 /month $ 371.47 /month $ 378.03 /month $ 387.16 /month $ 398.58 /month $ 411.99 /month $ 427.97 /month $ 445.95 /month $ 466.48 /month $ 486.74 /month $ 509.56 /month $ 532.11 /month $ 556.93 /month $ 582.04 /month $ 609.14 /month $ 636.25 /month $ 665.63 /month $ 695.31 /month $ 726.97 /month $ 742.66 /month $ 774.34 /month $ 801.73 /month $ 819.71 /month $ 842.24 /month $ 855.93 /month $ 855.93 /month
Gold PPO 250

Plan Details

Prescription drugs (30-day supply)
  • Generic: $7
  • Preferred: $30
  • Other brand name: $75
    ($30 copayment plus $45 other brand name cost share)
Additional benefits
$250 $6,350 30% $25 $ 154.89 /month $ 243.91 /month $ 243.91 /month $ 243.91 /month $ 243.91 /month $ 244.89 /month $ 249.77 /month $ 255.62 /month $ 265.14 /month $ 272.94 /month $ 276.84 /month $ 282.70 /month $ 288.55 /month $ 292.22 /month $ 296.12 /month $ 298.07 /month $ 300.02 /month $ 301.97 /month $ 303.92 /month $ 307.83 /month $ 311.73 /month $ 317.58 /month $ 323.19 /month $ 330.99 /month $ 340.75 /month $ 352.22 /month $ 365.88 /month $ 381.24 /month $ 398.80 /month $ 416.12 /month $ 435.64 /month $ 454.90 /month $ 476.12 /month $ 497.59 /month $ 520.77 /month $ 543.93 /month $ 569.06 /month $ 594.43 /month $ 621.50 /month $ 634.92 /month $ 661.99 /month $ 685.40 /month $ 700.77 /month $ 720.04 /month $ 731.73 /month $ 731.73 /month
Gold PPO 250 with Children’s Dental

Plan Details

Prescription drugs (30-day supply)
  • Generic: $7
  • Preferred: $30
  • Other brand name: $75
    ($30 copayment plus $45 other brand name cost share)
Additional benefits
$250 $6,350 30% $25 $ 155.40 /month $ 244.72 /month $ 244.72 /month $ 244.72 /month $ 244.72 /month $ 245.69 /month $ 250.59 /month $ 256.46 /month $ 266.00 /month $ 273.83 /month $ 277.75 /month $ 283.62 /month $ 289.49 /month $ 293.17 /month $ 297.08 /month $ 299.04 /month $ 301.00 /month $ 302.95 /month $ 304.91 /month $ 308.83 /month $ 312.74 /month $ 318.62 /month $ 324.25 /month $ 332.08 /month $ 341.87 /month $ 353.37 /month $ 367.07 /month $ 382.48 /month $ 400.10 /month $ 417.48 /month $ 437.06 /month $ 456.39 /month $ 477.68 /month $ 499.21 /month $ 522.46 /month $ 545.71 /month $ 570.92 /month $ 596.37 /month $ 623.53 /month $ 636.99 /month $ 664.16 /month $ 687.65 /month $ 703.06 /month $ 722.39 /month $ 734.14 /month $ 734.14 /month
Gold PPO 1000

Plan Details

Prescription drugs (30-day supply)
  • Generic: $7
  • Preferred: $30
  • Other brand name: $75
    ($30 copayment plus $45 other brand name cost share)
Additional benefits
$1,000 $4,000 10% $25 $ 154.70 /month $ 243.62 /month $ 243.62 /month $ 243.62 /month $ 243.62 /month $ 244.60 /month $ 249.47 /month $ 255.32 /month $ 264.82 /month $ 272.62 /month $ 276.52 /month $ 282.36 /month $ 288.20 /month $ 291.86 /month $ 295.76 /month $ 297.70 /month $ 299.65 /month $ 301.60 /month $ 303.55 /month $ 307.45 /month $ 311.35 /month $ 317.20 /month $ 322.80 /month $ 330.60 /month $ 340.34 /month $ 351.79 /month $ 365.43 /month $ 380.78 /month $ 398.33 /month $ 415.62 /month $ 435.11 /month $ 454.36 /month $ 475.55 /month $ 496.99 /month $ 520.14 /month $ 543.28 /month $ 568.37 /month $ 593.71 /month $ 620.75 /month $ 634.15 /month $ 661.19 /month $ 684.58 /month $ 699.93 /month $ 719.17 /month $ 730.86 /month $ 730.86 /month
Gold PPO 1000 with Children’s Dental

Plan Details

Prescription drugs (30-day supply)
  • Generic: $7
  • Preferred: $30
  • Other brand name: $75
    ($30 copayment plus $45 other brand name cost share)
Additional benefits
$1,000 $4,000 10% $25 $ 155.20 /month $ 244.42 /month $ 244.42 /month $ 244.42 /month $ 244.42 /month $ 245.40 /month $ 250.28 /month $ 256.15 /month $ 265.68 /month $ 273.51 /month $ 277.42 /month $ 283.28 /month $ 289.15 /month $ 292.82 /month $ 296.73 /month $ 298.68 /month $ 300.64 /month $ 302.59 /month $ 304.55 /month $ 308.46 /month $ 312.37 /month $ 318.24 /month $ 323.85 /month $ 331.67 /month $ 341.45 /month $ 352.94 /month $ 366.63 /month $ 382.03 /month $ 399.63 /month $ 416.98 /month $ 436.53 /month $ 455.84 /month $ 477.11 /month $ 498.62 /month $ 521.83 /month $ 545.06 /month $ 570.22 /month $ 595.65 /month $ 622.78 /month $ 636.22 /month $ 663.35 /month $ 686.81 /month $ 702.21 /month $ 721.53 /month $ 733.26 /month $ 733.26 /month
Gold HMO

Plan Details

Prescription drugs (30-day supply)
  • Generic: $7
  • Preferred: $30
  • Other brand name: $75
    ($30 copayment plus $45 other brand name cost share)
Additional benefits
$1,000 $4,000 10% $25 $ 151.66 /month $ 238.83 /month $ 238.83 /month $ 238.83 /month $ 238.83 /month $ 239.78 /month $ 244.55 /month $ 250.29 /month $ 259.61 /month $ 267.24 /month $ 271.06 /month $ 276.80 /month $ 282.53 /month $ 286.11 /month $ 289.93 /month $ 291.84 /month $ 293.75 /month $ 295.67 /month $ 297.58 /month $ 301.40 /month $ 305.22 /month $ 310.95 /month $ 316.44 /month $ 324.09 /month $ 333.64 /month $ 344.86 /month $ 358.24 /month $ 373.28 /month $ 390.48 /month $ 407.44 /month $ 426.54 /month $ 445.41 /month $ 466.19 /month $ 487.20 /month $ 509.89 /month $ 532.58 /month $ 557.17 /month $ 582.02 /month $ 608.52 /month $ 621.66 /month $ 648.17 /month $ 671.09 /month $ 686.14 /month $ 705.01 /month $ 716.47 /month $ 716.47 /month
Gold HMO with Children’s Dental

Plan Details

Prescription drugs (30-day supply)
  • Generic: $7
  • Preferred: $30
  • Other brand name: $75
    ($30 copayment plus $45 other brand name cost share)
Additional benefits
$1,000 $4,000 10% $25 $ 152.16 /month $ 239.62 /month $ 239.62 /month $ 239.62 /month $ 239.62 /month $ 240.58 /month $ 245.38 /month $ 251.13 /month $ 260.47 /month $ 268.14 /month $ 271.98 /month $ 277.72 /month $ 283.47 /month $ 287.07 /month $ 290.90 /month $ 292.82 /month $ 294.74 /month $ 296.65 /month $ 298.56 /month $ 302.40 /month $ 306.24 /month $ 311.99 /month $ 317.49 /month $ 325.16 /month $ 334.75 /month $ 346.01 /month $ 359.43 /month $ 374.53 /month $ 391.79 /month $ 408.80 /month $ 427.96 /month $ 446.89 /month $ 467.74 /month $ 488.82 /month $ 511.59 /month $ 534.35 /month $ 559.03 /month $ 583.96 /month $ 610.55 /month $ 623.74 /month $ 650.33 /month $ 673.34 /month $ 688.43 /month $ 707.36 /month $ 718.86 /month $ 718.86 /month
Silver PPO 1500

Plan Details

Prescription drugs (30-day supply)
  • Generic: $7
  • Preferred: $30
  • Other brand name: $75
    ($30 copayment plus $45 other brand name cost share)
Additional benefits
$1,500 $6,350 40% $30 $ 123.80 /month $ 194.97 /month $ 194.97 /month $ 194.97 /month $ 194.97 /month $ 195.75 /month $ 199.65 /month $ 204.33 /month $ 211.93 /month $ 218.17 /month $ 221.29 /month $ 225.97 /month $ 230.65 /month $ 233.58 /month $ 236.69 /month $ 238.25 /month $ 239.81 /month $ 241.38 /month $ 242.93 /month $ 246.05 /month $ 249.17 /month $ 253.85 /month $ 258.34 /month $ 264.57 /month $ 272.37 /month $ 281.53 /month $ 292.45 /month $ 304.74 /month $ 318.77 /month $ 332.62 /month $ 348.22 /month $ 363.61 /month $ 380.58 /month $ 397.74 /month $ 416.26 /month $ 434.78 /month $ 454.86 /month $ 475.13 /month $ 496.78 /month $ 507.50 /month $ 529.14 /month $ 547.86 /month $ 560.14 /month $ 575.55 /month $ 584.91 /month $ 584.91 /month
Silver PPO 1500 with Children’s Dental

Plan Details

Prescription drugs (30-day supply)
  • Generic: $7
  • Preferred: $30
  • Other brand name: $75
    ($30 copayment plus $45 other brand name cost share)
Additional benefits
$1,500 $6,350 40% $30 $ 124.92 /month $ 196.73 /month $ 196.73 /month $ 196.73 /month $ 196.73 /month $ 197.51 /month $ 201.45 /month $ 206.18 /month $ 213.84 /month $ 220.14 /month $ 223.29 /month $ 228.01 /month $ 232.73 /month $ 235.68 /month $ 238.83 /month $ 240.40 /month $ 241.98 /month $ 243.55 /month $ 245.12 /month $ 248.27 /month $ 251.42 /month $ 256.14 /month $ 260.66 /month $ 266.96 /month $ 274.83 /month $ 284.07 /month $ 295.09 /month $ 307.49 /month $ 321.65 /month $ 335.62 /month $ 351.35 /month $ 366.90 /month $ 384.02 /month $ 401.32 /month $ 420.02 /month $ 438.71 /month $ 458.97 /month $ 479.43 /month $ 501.27 /month $ 512.08 /month $ 533.92 /month $ 552.81 /month $ 565.20 /month $ 580.75 /month $ 590.18 /month $ 590.18 /month
Silver PPO 2000

Plan Details

Prescription drugs (30-day supply)
  • Generic: $7
  • Preferred: $30
  • Other brand name: $75
    ($30 copayment plus $45 other brand name cost share)
Additional benefits
$2,000 $5,500 30% $30 $ 123.30 /month $ 194.18 /month $ 194.18 /month $ 194.18 /month $ 194.18 /month $ 194.95 /month $ 198.84 /month $ 203.49 /month $ 211.07 /month $ 217.29 /month $ 220.39 /month $ 225.06 /month $ 229.72 /month $ 232.62 /month $ 235.73 /month $ 237.28 /month $ 238.84 /month $ 240.39 /month $ 241.94 /month $ 245.05 /month $ 248.16 /month $ 252.82 /month $ 257.29 /month $ 263.50 /month $ 271.26 /month $ 280.39 /month $ 291.27 /month $ 303.50 /month $ 317.48 /month $ 331.27 /month $ 346.80 /month $ 362.14 /month $ 379.04 /month $ 396.12 /month $ 414.58 /month $ 433.02 /month $ 453.02 /month $ 473.22 /month $ 494.77 /month $ 505.45 /month $ 527.00 /month $ 545.64 /month $ 557.88 /month $ 573.21 /month $ 582.53 /month $ 582.53 /month
Silver PPO 2000 with Children’s Dental

Plan Details

Prescription drugs (30-day supply)
  • Generic: $7
  • Preferred: $30
  • Other brand name: $75
    ($30 copayment plus $45 other brand name cost share)
Additional benefits
$2,000 $5,500 30% $30 $ 124.42 /month $ 195.94 /month $ 195.94 /month $ 195.94 /month $ 195.94 /month $ 196.72 /month $ 200.64 /month $ 205.34 /month $ 212.99 /month $ 219.26 /month $ 222.39 /month $ 227.10 /month $ 231.80 /month $ 234.73 /month $ 237.87 /month $ 239.44 /month $ 241.00 /month $ 242.57 /month $ 244.14 /month $ 247.28 /month $ 250.40 /month $ 255.12 /month $ 259.62 /month $ 265.89 /month $ 273.72 /month $ 282.93 /month $ 293.91 /month $ 306.25 /month $ 320.36 /month $ 334.27 /month $ 349.94 /month $ 365.42 /month $ 382.47 /month $ 399.72 /month $ 418.33 /month $ 436.94 /month $ 457.13 /month $ 477.50 /month $ 499.26 /month $ 510.03 /month $ 531.77 /month $ 550.58 /month $ 562.93 /month $ 578.41 /month $ 587.81 /month $ 587.81 /month
Silver HMO

Plan Details

Prescription drugs (30-day supply)
  • Generic: $7
  • Preferred: $30
  • Other brand name: $75
    ($30 copayment plus $45 other brand name cost share)
Additional benefits
$2,000 $5,500 30% $30 $ 120.87 /month $ 190.33 /month $ 190.33 /month $ 190.33 /month $ 190.33 /month $ 191.09 /month $ 194.90 /month $ 199.47 /month $ 206.89 /month $ 212.98 /month $ 216.03 /month $ 220.60 /month $ 225.17 /month $ 228.02 /month $ 231.07 /month $ 232.58 /month $ 234.10 /month $ 235.63 /month $ 237.15 /month $ 240.20 /month $ 243.24 /month $ 247.81 /month $ 252.19 /month $ 258.28 /month $ 265.89 /month $ 274.84 /month $ 285.49 /month $ 297.49 /month $ 311.19 /month $ 324.71 /month $ 339.93 /month $ 354.97 /month $ 371.52 /month $ 388.28 /month $ 406.36 /month $ 424.44 /month $ 444.05 /month $ 463.84 /month $ 484.97 /month $ 495.44 /month $ 516.56 /month $ 534.83 /month $ 546.83 /month $ 561.86 /month $ 570.99 /month $ 570.99 /month
Silver HMO with Children’s Dental

Plan Details

Prescription drugs (30-day supply)
  • Generic: $7
  • Preferred: $30
  • Other brand name: $75
    ($30 copayment plus $45 other brand name cost share)
Additional benefits
$2,000 $5,500 30% $30 $ 121.98 /month $ 192.09 /month $ 192.09 /month $ 192.09 /month $ 192.09 /month $ 192.86 /month $ 196.70 /month $ 201.31 /month $ 208.81 /month $ 214.95 /month $ 218.03 /month $ 222.64 /month $ 227.25 /month $ 230.12 /month $ 233.20 /month $ 234.73 /month $ 236.28 /month $ 237.81 /month $ 239.34 /month $ 242.42 /month $ 245.49 /month $ 250.10 /month $ 254.52 /month $ 260.67 /month $ 268.35 /month $ 277.38 /month $ 288.13 /month $ 300.24 /month $ 314.07 /month $ 327.71 /month $ 343.08 /month $ 358.25 /month $ 374.97 /month $ 391.87 /month $ 410.12 /month $ 428.37 /month $ 448.15 /month $ 468.13 /month $ 489.45 /month $ 500.02 /month $ 521.33 /month $ 539.78 /month $ 551.88 /month $ 567.06 /month $ 576.27 /month $ 576.27 /month
Bronze PPO 6350

Plan Details

Prescription drugs (30-day supply)
  • Generic*: $7
  • Preferred: $0
  • Other brand name: $0
Additional benefits

Fitness membership
(With $75 annual copayment)

$6,350 $6,350 0% $0 $ 79.62 /month $ 125.40 /month $ 125.40 /month $ 125.40 /month $ 125.40 /month $ 125.89 /month $ 128.40 /month $ 131.42 /month $ 136.30 /month $ 140.31 /month $ 142.33 /month $ 145.33 /month $ 148.35 /month $ 150.23 /month $ 152.23 /month $ 153.23 /month $ 154.24 /month $ 155.24 /month $ 156.24 /month $ 158.25 /month $ 160.25 /month $ 163.27 /month $ 166.15 /month $ 170.16 /month $ 175.18 /month $ 181.07 /month $ 188.10 /month $ 195.99 /month $ 205.02 /month $ 213.92 /month $ 223.96 /month $ 233.86 /month $ 244.77 /month $ 255.81 /month $ 267.72 /month $ 279.63 /month $ 292.55 /month $ 305.59 /month $ 319.51 /month $ 326.40 /month $ 340.33 /month $ 352.36 /month $ 360.26 /month $ 370.16 /month $ 376.19 /month $ 376.19 /month
Bronze PPO 6350 with Children’s Dental

Plan Details

Prescription drugs (30-day supply)
  • Generic*: $7
  • Preferred: $0
  • Other brand name: $0
Additional benefits

Fitness membership
(With $75 annual copayment)

$6,350 $6,350 0% $0 $ 81.05 /month $ 127.65 /month $ 127.65 /month $ 127.65 /month $ 127.65 /month $ 128.16 /month $ 130.72 /month $ 133.77 /month $ 138.75 /month $ 142.84 /month $ 144.88 /month $ 147.94 /month $ 151.01 /month $ 152.93 /month $ 154.97 /month $ 155.98 /month $ 157.01 /month $ 158.03 /month $ 159.05 /month $ 161.09 /month $ 163.13 /month $ 166.20 /month $ 169.14 /month $ 173.22 /month $ 178.33 /month $ 184.33 /month $ 191.47 /month $ 199.51 /month $ 208.70 /month $ 217.77 /month $ 227.98 /month $ 238.07 /month $ 249.18 /month $ 260.41 /month $ 272.53 /month $ 284.66 /month $ 297.80 /month $ 311.09 /month $ 325.25 /month $ 332.27 /month $ 346.44 /month $ 358.70 /month $ 366.74 /month $ 376.83 /month $ 382.95 /month $ 382.95 /month
Bronze HMO

Plan Details

Prescription drugs (30-day supply)
  • Generic*: $7
  • Preferred: $0
  • Other brand name: $0
Additional benefits

Fitness membership
(With $75 annual copayment)

$6,350 $6,350 0% $0 $ 78.27 /month $ 123.26 /month $ 123.26 /month $ 123.26 /month $ 123.26 /month $ 123.76 /month $ 126.23 /month $ 129.18 /month $ 133.99 /month $ 137.94 /month $ 139.91 /month $ 142.86 /month $ 145.82 /month $ 147.67 /month $ 149.65 /month $ 150.63 /month $ 151.62 /month $ 152.60 /month $ 153.59 /month $ 155.56 /month $ 157.53 /month $ 160.49 /month $ 163.33 /month $ 167.27 /month $ 172.20 /month $ 177.99 /month $ 184.90 /month $ 192.67 /month $ 201.53 /month $ 210.29 /month $ 220.15 /month $ 229.89 /month $ 240.61 /month $ 251.46 /month $ 263.17 /month $ 274.88 /month $ 287.58 /month $ 300.39 /month $ 314.08 /month $ 320.86 /month $ 334.54 /month $ 346.38 /month $ 354.14 /month $ 363.88 /month $ 369.78 /month $ 369.78 /month
Bronze HMO with Children’s Dental

Plan Details

Prescription drugs (30-day supply)
  • Generic*: $7
  • Preferred: $0
  • Other brand name: $0
Additional benefits

Fitness membership
(With $75 annual copayment)

$6,350 $6,350 0% $0 $ 79.70 /month $ 125.52 /month $ 125.52 /month $ 125.52 /month $ 125.52 /month $ 126.02 /month $ 128.53 /month $ 131.54 /month $ 136.43 /month $ 140.46 /month $ 142.47 /month $ 145.47 /month $ 148.49 /month $ 150.37 /month $ 152.38 /month $ 153.38 /month $ 154.39 /month $ 155.40 /month $ 156.40 /month $ 158.40 /month $ 160.41 /month $ 163.43 /month $ 166.31 /month $ 170.33 /month $ 175.35 /month $ 181.25 /month $ 188.28 /month $ 196.18 /month $ 205.22 /month $ 214.14 /month $ 224.18 /month $ 234.09 /month $ 245.01 /month $ 256.06 /month $ 267.98 /month $ 279.91 /month $ 292.84 /month $ 305.89 /month $ 319.82 /month $ 326.73 /month $ 340.66 /month $ 352.71 /month $ 360.62 /month $ 370.53 /month $ 376.55 /month $ 376.55 /month
Young Adults with Children’s Dental

Plan Details

Prescription drugs (30-day supply)
  • Generic: $7
  • Preferred: $30
  • Other brand name: $75
    ($30 copayment plus $45 other brand name cost share)

First three visits are covered before you reach the deductible.

Additional benefits

Fitness membership
(With $75 annual copayment)

$5,000 $6,350 50% $50 $ 84.45 /month $ 132.98 /month $ 132.98 /month $ 132.98 /month $ 132.98 /month $ 133.52 /month $ 136.17 /month $ 139.37 /month $ 144.55 /month $ 148.80 /month Not eligible
Catastrophic Plan with Children’s Dental

Plan Details

Prescription drugs (30-day supply)
  • Generic: $7
  • Preferred: $30
  • Other brand name: $75
    ($30 copayment plus $45 other brand name cost share)

First three visits are covered before you reach the deductible.

Additional benefits

Fitness membership
(With $75 annual copayment)

$5,000 $6,350 50% $50 $ 84.45 /month $ 132.98 /month $ 132.98 /month $ 132.98 /month $ 132.98 /month $ 133.52 /month $ 136.17 /month $ 139.37 /month $ 144.55 /month $ 148.80 /month $ 150.94 /month $ 154.13 /month $ 157.32 /month $ 159.32 /month $ 161.44 /month $ 162.50 /month $ 163.57 /month $ 164.64 /month $ 165.69 /month $ 167.83 /month $ 169.95 /month $ 173.15 /month $ 176.21 /month $ 180.46 /month $ 185.78 /month $ 192.03 /month $ 199.47 /month $ 207.85 /month $ 217.43 /month $ 226.87 /month $ 237.51 /month $ 248.02 /month $ 259.59 /month $ 271.29 /month $ 283.92 /month $ 296.55 /month $ 310.25 /month $ 324.09 /month $ 338.84 /month $ 346.15 /month $ 360.92 /month $ 373.69 /month $ 382.07 /month $ 392.57 /month $ 398.94 /month $ 398.94 /month
  1. Member’s cost after the deductible is met.
  2. First three visits are covered before you reach the deductible.
  3. $50 copayment plus $50 other brand name cost share.
  4. $30 copayment plus $45 other brand cost share.

Health benefits Dental benefits
These benefits are included in all HMSA individual plans, and many are available as soon as you enroll:
  • HMSA’s Online Care.
  • An annual physical/wellness exam with no copayment.
  • Generic drug coverage*.
  • Adult vision coverage.

*Generic drugs are covered before you meet the deductible, excluding single source generic drugs (manufactured by a single pharmaceutical company) dispensed at a pharmacy.

Children’s dental benefit (if included)
  • Preventive services such as oral exams, teeth cleaning, and X-rays with no copayment.
  • Basic services such as fillings, extractions, and root canals; members pay 30%.
  • Major services such as crowns, and dentures; members pay 50%.
  • The embedded children’s dental benefit (if applicable) is subject to the metallic plan’s annual deductible before coverage begins.

Health benefits

Dental benefits

medicare eligibility trigger