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2012 Akamai Advantage Preferred

Monthly Premium
$54.00* Available Statewide

Receive the security of knowing that this comprehensive coverage will help pay for the health care you need.

Plan Features

  • Set copayment for hospitalization.
  • Set copayments for doctor’s visits.
  • Access to Akamai Advantage’s statewide network of doctors, specialists, and other health care providers.
    (Download Provider Directory)
  • Prescription drug coverage.
  • Financial protection with annual out-of-pocket maximum.
  • Worldwide coverage for emergency care.
  • Exclusive value-added discounts for dental services.
  • Valuable discounts for vision, hearing, and other health care services.
* You must continue to pay your Medicare Part B premium.
Benefits

What you pay when you use Akamai Advantage Preferred

Medicare-covered Services You Pay
All plan benefits are based on in-network services.
1. $0 copayment for additional hospital days.
2. Physician visit copayment may apply.
Physician visits $15 Primary Care Physician
$15 Specialist
Inpatient hospital care1 $300 per Medicare-covered hospital stay
Outpatient services/surgery2 $15
Ambulance service $50
Emergency room; urgent care facility $50
X-rays (diagnostic) $15

What you pay for prescription drugs

Medicare-covered Services Phase You Pay
$0 - $150 Annual Deductible $150
$150 to $2,930 in total drug spending Initial Coverage Period Tier 1: $4
Tier 2: $30
Tier 3: $65
Tier 4: 25%
$2,930 in total drug spending to $4,700 in true out-of-pocket costs Coverage Gap Generic: 86%
Brand: 50%
$4,700 and higher in true out-of-pocket costs Catastrophic Coverage Period Tier 1: $2.60
Tier 2: $6.50
Tier 3: $6.50
Tier 4: 5%

You must use network pharmacies to access your prescription drug benefit, except under non-routine circumstances. Quantity limitations and restrictions may apply.

  • The plan information provided here is effective Jan. 1, 2012. Benefits, premiums, and copayments may change on Jan. 1, 2013.
  • Limitations, copayments, and restrictions may apply.
  • With the exception of emergencies or urgent care, it may cost more to get care from out-of-network providers.
  • The benefit information provided here is a brief summary, not a comprehensive description of benefits. For more information, contact the plan.
Eligibility

You are eligible to enroll in Akamai Advantage if you:

  • Have Medicare Part A and are enrolled in Part B.
  • Live in the state of Hawaii.
  • Do not have end-stage renal disease (ESRD). HMSA members who have ESRD are allowed to enroll in Akamai Advantage if they also meet other enrollment eligibility requirements.

You may enroll in the plan only during specific times of the year. Contact HMSA for more information. Medicare open enrollment is Oct. 15 - Dec. 7.

Akamai Advantage is a Health plan with a Medicare contract.

Drug Tools
Formulary Search (Comprehensive)

HMSA’s formulary is a list of Medicare-approved drugs covered by your health or drug plan.

Find a Pharmacy

Network pharmacies contract with HMSA so members can get their prescription drug benefits. In most cases, prescriptions are covered only if they are filled at a network pharmacy.

Drug Comparison Tool

Find out if your drug is covered on HMSA's formulary, find available alternatives, and monitor your benefit status in relation to the Medicare Part D coverage gap (also called the "doughnut hole").

Mail Order Prescription Drug Program

This cost-efficient, convenient way to receive your maintenance medications can reduce your prescription copayments and have your medications delivered directly to you.

Extra Help

Extra Help, also known as Low Income Subsidy, is a program that can help you pay for your prescription drug premiums and copayments.

Coverage Determination
Coverage Decision (also called Coverage Determination) - EOC Chapter 9, Sec. 6.4

You may call or write to your plan to request a formal decision about prescribed drug coverage.

You can make an appeal if you disagree with a decision that denies your request for prescription drugs or payment of drugs you received.

Prior Authorization, Step Therapy and Quantity Limits

With Akamai Advantage, prior authorization is required for certain prescription drugs. To help manage our members’ health care costs, Akamai Advantage providers must contact HMSA before prescribing certain drugs. Step-therapy requirements and quantity limits also apply for some drugs. You can review a list of your plan’s drug prior authorizations, step therapy requirements, and quantity limits.

Transition Process
Transition Process - EOC Chapter 5, Sec 6.2

Under certain circumstances, HMSA can offer a temporary supply of a prescription drug to you when your drug is not on the Drug List or when it is restricted in some way. Doing this gives you time to talk with your provider and figure out what to do.

Member Resources
Contact HMSA

For help or more information about Akamai Advantage.

Akamai Advantage Dental Discount Program

Members receive exclusive value-added discounts for dental services.

HMSA365

Valuable discounts for vision, hearing, and other health care services.

Visitor/Travel Program

Coverage while traveling on the Mainland through the Blue Medicare Advantage PPO Network.

Dues Payment Service/EFT

HMSA’s Dues Payment Service is a simple, convenient way to save the time and expense of mailing monthly payments. With your authorization, HMSA will work directly with your local financial institution to transfer monthly dues payments to HMSA for your health plan and prescription drug coverage.

Appointing a representative

You can name another person to act as your representative for certain health care decisions.

Akamai Advantage Change form

Current Akamai Advantage members can use this form to choose a different Akamai Advantage plan. Contact us for more information.

Interpretive services

HMSA offers interpreter services at no charge. If you need an interpreter, please call Customer Service or visit your nearest HMSA office Monday through Friday, 8 a.m. to 4 p.m.

Organization determination
Coverage decisions (also called Organization Determinations) - EOC Chapter 9, Sec. 5.2

Contact HMSA if you have a question about whether a medical service is covered under your plan or how much it will cost you.

You can make an appeal if you disagree with a decision to deny a request for health care services or payment of services you received.

HMSA provides a process if you need to make a complaint about quality of care, waiting times, customer service, or other concerns that are not related to benefits, coverage or payment.

Member card

Akamai Advantage members receive HMSA membership cards that contain important health plan information. Take your card with you whenever you receive medical and prescription drug services.

Prior authorization

With Akamai Advantage, prior authorization, also known as precertification, is required for certain medical services. To help manage our members’ health care costs, Akamai Advantage providers must contact HMSA before providing or ordering certain medical services. Please review the Evidence of Coverage to learn more about your plan’s specific prior authorizations.

Links

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