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2009 65C Plus – High Option

To learn more about HMSA’s 65C Plus, attend a free informational session.

Health benefits beyond traditional Medicare to provide the security of comprehensive health coverage:

  • Stay on top of your health with HealthPass, HMSA’s award-winning health promotion and disease prevention program.
  • Have peace of mind knowing your plan covers emergency and urgent care while traveling abroad.

For more detailed explanation, please refer to the appropriate plan option Summary of Benefits or Evidence of Coverage brochure.

65C Plus is easy to use. There’s no paperwork when you use 65C Plus contracting providers, no worries about waiting periods or health screenings, and you'll never lose your coverage because of your health status.

Contact

For enrollment information, contact our representatives:
Telephone hours are 8 a.m. to 4 p.m., Monday through Friday.

Oahu: (808) 948-5555
Neighbor Islands: 1 (800) 620-4672 (toll-free)

For the hearing- and speech-impaired: TTY/TDD 1 (808) 948-6222

Current 65C Plus members with questions about their plan may contact Customer Service from 8 a.m. to 4 p.m., Monday through Friday.

Plan Materials

Member Information

Appeals & Grievances

65C Plus has a contract with the Centers for Medicare & Medicaid Services (CMS), the government agency that runs the Medicare program. This contract renews each year. At the end of each year, the contract is reviewed, and either 65C Plus or CMS can decide to end it. It is possible for our contract to end at some other time during the year, too. If the contract should end, HMSA will provide advance notice to all 65C Plus members.

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Plan Monthly Premium
High Option for beneficiaries with Part A and Part B $89.00
High Option for beneficiaries with Part B only $67.00

Features


Medicare-Covered
Benefit		 High Option
Physician visits. $22
Lab services.1 $0
Tests (diagnostic or therapeutic), X-rays, radiology.1 $0
Facility charge.2 $22
Inpatient hospital care.3 $200 per benefit period then $0 copay3
Outpatient services/surgery.2 $22
Ambulance service. $0
Emergency room; urgent care facility. $50

Optional Benefits High Option
65C Plus noncontracting provider benefits. Available.
HealthPass
(annual health risk assessment).		 Available.
365 additional hospital days per calendar year. Available.
Private duty nursing. Available.
Worldwide coverage. Available.

1 Facility charge may apply for each service.
2 Physician visit copayment may apply.
3 After 90 days, $0 for Medicare lifetime reserve days (if available).


Eligibility

  • You must be entitled to Medicare Part A and enrolled in Medicare Part B, or enrolled in Medicare Part B only.
  • You must be a permanent resident of the state of Hawaii. If you remain outside of the state of Hawaii for more than 90 consecutive days, you are no longer considered a resident in the 65C Plus service area and you must leave the plan.
  • You must not have end-stage renal disease (ESRD) that requires routine dialysis or a kidney transplant, unless you have been a continuous HMSA health plan member since your Medicare Part B effective date.
  • You must be a 65C Plus health plan member to enroll in HMSA's 65C Plus Prescription Drug Coverage option.
  • You must continue to pay your Medicare Part B premium in addition to the 65C Plus plan premium. Most people pay the standard monthly Part B premium. However, some people have to pay a higher Medicare Part B premium because of their yearly income. For more information on Part B premiums based on income, call the Social Security Administration at 1 (800) 772-1213. TTY/TDD users should call 1 (800) 325-0778. Agents are available Monday through Friday, 7 a.m. to 7 p.m. Hawaii Standard Time.
  • If you only have Medicare Part B, you are eligible for Medicare-covered Part B services only, which do not include inpatient hospital, skilled nursing facility, and hospice services.
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