2013 Akamai Advantage Assured

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  8 a.m. to 8 p.m.
  Seven days a week
  1 (800) 620-4672
  TTY: 711
  
  HMSA Akamai Advantage
  P.O. Box 860
  Honolulu, HI 96808-0860

• Email: Akamai@hmsa.com
• Find a Doctor
• Attend a Medicare Session

Monthly Premium

$21.00* Available Statewide

An Akamai Advantage plan designed for those who already have a creditable drug plan through their employer or spouse’s employer. Receive comprehensive health coverage beyond traditional Medicare benefits.

Plan Features

• Hospital and medical services.
• Access to Akamai Advantage’s large statewide network of doctors, specialists, and other health care providers.
  (Download Provider Directory)
• Peace of mind with worldwide emergency care coverage.
• Exclusive value-added discounts for dental services.
• Valuable discounts through HMSA365, our exclusive member discount program that includes vision, hearing, and other health care services.

Benefits

What you pay when you use Akamai Advantage Assured

• More Information
• Summary of Benefits
• 2013 Plan Ratings
• Evidence of Coverage

Service	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 $25 Specialist
Inpatient hospital care1	Days 1-7: $125/day Days 8-90: $0/day
Outpatient services/surgery2	$25
Ambulance service	$50
Emergency room; urgent care facility	$50
X-rays (diagnostic)	$25

• The plan information provided here is effective Jan. 1, 2013. Benefits, premium, and/or copayments/coinsurance may change on Jan. 1 of each year.
• 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.
• Medicare beneficiaries may also enroll in Akamai Advantage Assured through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.
• Plan performance Star Ratings are assessed each year and may change from one year to the next.

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.

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.

Ending your membership in the plan (Disenrollment) – EOC Chapter 8

Akamai Advantage and our members have rights and responsibilities when a member leaves our plan.

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 7, 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.

Exceptions and appeals
Appeals - EOC Chapter 7, Sec 5.3

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.

Grievance
Grievances - EOC Chapter 7, Sec 9.3
Important Phone Numbers and Resources - EOC Chapter 2

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.

To obtain an aggregate number of grievances, appeals, and exceptions filed with Akamai Advantage, contact Customer Service.