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• Filing Medical Claims for Services from Nonparticipating Providers

  Providers will usually submit claims for you. If they don't, you can submit a claim yourself by following these steps.

• Organization Determination (Request for Prior Authorization)

  Some services and medical care require a coverage decision by HMSA before they can be covered.

• HMSA Medicare Advantage Coverage Determination Request

  Fill out this form if you have Medicare Part D and want to know if HMSA will cover a prescription drug and how much it will cost you.

• HMSA Medicare Advantage Member Appeals

  You can ask us to recheck a decision about your health plan or prescription drug coverage for services or benefits you've received.

• ACA Plan Resources

  This transparency in coverage will tell you how to submit claims, get preauthorization, and see if a prescription drug is covered.

• Annual Cost Savings Reports Discontinued

  The Annual Cost Savings Report was discontinued in January 2020.

• Order Your Prescription Drugs through the Mail

  You can save money with mail-order drugs because copayments are generally lower than when you buy a smaller supply from retail pharmacies.

• Is There a Generic Equivalent for My Brand-name Drug?

  By checking your HMSA formulary, you can see if there are any generic drug alternatives to any brand-name drugs you may be taking.

• Improved Access to Claim Information Available in My Account

  HMSA's My Account now offers a better way to view your in-state and out-of-state claims information for most plans.

• Guest Membership on the Mainland for HMO Members

  If you're an HMSA HMO member living away from Hawaii for more than 90 days, you may have access to participating Blue Cross and Blue Shield providers through the Guest Membership program.

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