Note: If your plan has an annual deductible, you need to meet the annual deductible before HMSA will pay for certain services. If you’re not sure your plan has an annual deductible, please check your Guide to Benefits. For easy access to your plan details, log in to your HMSA My Account at hmsa.com.
If you receive medical care from a BlueCard participating provider while away from Hawaii, you’ll pay the participating provider copayment specified in your Guide to Benefits.
If you receive medical care from a provider who doesn’t participate with the local Blue Cross or Blue Shield plan:
- You may be required to pay the provider’s total charge before you leave the provider’s office or facility. Before your visit to the provider, we recommend asking the provider when they expect payment.
- If you need to be reimbursed for services, you may have to file a claim with HMSA. Start by asking the provider if they can submit the claim for you. If they can’t, you’ll need to send it.
Follow the instructions for filing medical claims for services from nonparticipating providers. To make things easier, ask the provider to help you complete the claim form. Claims must be submitted within one year of the last day you received services. For HMSA’s Plan for Federal Employees and the Postal Service plan, you have until Dec. 31 of the year after the services were received. Refer to the federal plan brochure or the postal service plan brochure for more information.
Below is an example of how your portion of the costs for covered services may be calculated for a major surgical procedure performed outside Hawaii. The figures listed are for illustration purposes only. The cost of actual services rendered may vary. Your copayment will be what’s specified in your Guide to Benefits.
| BlueCard Provider | Participating (PPO provider) |
Nonparticipating |
|---|---|---|
| Provider’s Actual Charge | $100,000 | $100,000 |
| Eligible Charge | $40,000 | $40,000 |
| Your Copayment | 10% of eligible charge | 30% of eligible charge |
| Calculation to Determine Your Portion of the Costs | $40,000 x 10% = $4,000 | $40,000 x 30% = $12,000 Difference between eligible charge and actual charge = $60,000 ($100,000 - $40,000) $12,000 + $60,000 = $72,000 |
| Your Portion | $4,000 | $72,000* |
*Note: Because services were received from a nonparticipating provider, you owe the provider the actual charge of $100,000 and you may need to file your own claim. Based on this example, a benefit payment of $28,000 (the eligible charge of $40,000 x 70%) is reimbursed to you.
If your plan has an annual deductible that applies to the services you receive, the annual deductible must be met before you can use your benefits. To see if your plan has an annual deductible, log in to My Account on hmsa.com, select Benefits, and then Medical Benefits. For general information about annual deductibles, please visit What’s an Annual Deductible?
Your portion of the costs for services is calculated using the local Blue Cross Blue Shield plan’s eligible charge and your copayment stated in your Guide to Benefits. The eligible charge varies between Blue Cross Blue Shield plans.