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• Patient Centered Medical Home: A Path to Quality, Affordable Health Care

  A patient-centered medical home is not a building, it's a model of care designed to better coordinate your care with an emphasis on your overall well-being.

• When Prior Approval (Precertification) is Denied or Not Requested

  If your precertification request is denied and you disagree with HMSA's decision, you or your provider may submit an appeal.

• What's an Eligible Charge?

  The eligible charge is the lower of the participating provider's actual charge or HMSA's maximum allowable fee.

• What's a Report to Member?

  The Report to Member is an explanation of benefits. It is not a bill for services or supplies.

• What's an Annual Deductible?

  The annual deductible is a fixed dollar amount you pay for covered services each calendar year or plan year before HMSA will pay for certain services.

• What's an Annual Copayment Maximum?

  The annual copayment maximum is a fixed limit or cap to your total out-of-pocket expenses for most covered services in a calendar year or plan year.

• What's a Lifetime Maximum?

  A lifetime maximum is the maximum dollar amount that will be paid on your behalf under your HMSA plan.

• What’s a Benefit Maximum?

  A benefit maximum is a limit on a covered service or supply. A service or supply may be limited by dollar amount, duration, or number of visits.

• What if I Need Medical Care on the Mainland?

  Depending on your medical plan, you can receive services such as emergency and urgent care, or see a physician for a covered benefit while traveling on the Mainland.

• 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.

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