Understanding Health Plans
Choosing a Plan
Are you searching for a health plan, but not sure which one to choose? Choosing
the right health plan to suit your health and financial situation is important.
The two most common types of health plans are:
- Preferred Provider Organization (PPO). A PPO allows you to choose
any health care provider, but offers incentives to members who choose "preferred"
or network physicians or hospitals. Providers within this network agree to accept
a set fee from the health plan, while members are responsible for a small portion
of the cost, called a copayment. An example of a PPO is HMSA’s Preferred Provider
Plan (PPP). The PPP has the largest network of health care providers in the state,
including all major hospitals.
- Health Maintenance Organization (HMO). An HMO is a managed care
plan that requires you to select a personal care provider (PCP) who will treat
you and coordinate your care with specialists and other health care providers under
a single health center. An HMO comes with fixed copayments, which make the cost
of your health care predictable. An example of an HMO plan is HMSA’s Health
Choosing a Provider
When you coordinate your care through a primary care provider (PCP), you’re
developing a relationship with a trusted doctor who will understand your unique
health care needs. While not all of our plans require that you choose a PCP, having
one is a great way to help you make the most of your HMSA coverage.
HMSA members have convenient access to the largest provider network in the state.
HMSA participating providers have agreed to limit what they charge our members.
We encourage you to choose a participating provider to keep your out-of-pocket expenses
down. Need to find a physician? Browse our list of participating providers at Find a Doctor. If you already have a doctor,
check if they participate with HMSA.
Understanding Your Coverage
It is important to become familiar with things like copayments, co-insurance, deductibles,
covered and non-covered services, and how and where to get care. In addition to
getting the regular preventive care you need, you should know what, when and how
much you’ll pay for health care services. Read your Guide to Benefits and
Member Handbook or contact
your plan administrator to learn what’s covered by your plan.
Register For My Account
Register for My Account and you’ll
have the convenience of managing your coverage safely and securely.
- View your specific health plan coverage, benefits and more.
- View your medical and drug claims statements.
- Submit requests for change of address or duplicate HMSA cards.
- Search for prescription drug information.
Some features and functions not available for some plans.
Carry Your HMSA Card
Your HMSA card gives you access to the care you need, when you need it, wherever
you go – at home or on the Mainland. This card has phone numbers to call if you
have questions or to access your medical care. It also gives providers valuable
information about you and your coverage, whether you’re at your physician’s
office, the drugstore or the emergency room.
Some health plans may include supplemental benefit coverage for prescription drugs
and dental, vision, and complementary care (acupuncture, chiropractic care and massage
therapy). Just like the health plans, supplemental coverage usually comes in a PPO
or HMO version.