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• Using Nonparticipating Providers for Physical or Occupational Therapy

  If you're currently seeing a provider outside Hawaii or a nonparticipating provider for therapy services, ask the provider to submit a precertification request for any services.

• Services Your Plan Doesn't Cover

  Our benefits are designed to keep you safe, promote correct use of services, and keep health care costs down.

• Services that are Reconstructive, Corrective, or Cosmetic

  Reconstructive or corrective services are a benefit of your plan when they're required to restore, reconstruct, or correct a bodily function that was lost, impaired, or damaged due to an illness or injury.

• Prior Approval For Medical Services (Precertification)

  For some services, you or your physician must get approval from HMSA to make sure the services meet our payment guidelines.

• Seeing Specialists and Other Providers When You’re an HMO Member

  As an HMO member, your primary care provider coordinates your medical care and will refer you to specialists when needed.

• Screening and Diagnostic Tests

  HMSA plans cover a variety of tests that can fall under one of two categories: screening or diagnostic. The reason you are taking a test determines the category.

• Request For Insurance Commissioner External Review

  You can ask to have an independent review organization look over your appeal if you think we made a mistake.

• Find an HMSA Participating Retail Pharmacy

  You can use the Find a Doctor tool to find an HMSA participating pharmacy, too. Find out how it works.

• Physical Exams

  Your physical exam benefits will cover a checkup and any vision, hearing, or other recommended screening tests appropriate for your age and gender.

• Physical and Occupational Therapy FAQs

  HMSA covers short-term physical and occupational therapy that's been diagnosed and ordered by a physician, physician's assistant, or advanced practice registered nurse.

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