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• Where to Mail Your Claim for Medical Services and Supplies

  Learn where to send your claims for medical services and supplies.

• View Dental Claims Online

  Your dental claims information is accessible online through My Account on hmsa.com.

• When You Don't Recognize a Provider on Your Report to Member

  Don't worry if you see a name you don't recognize on your report to member. The provider may have asked for laboratory, diagnostic, anesthesia, or other service with no direct contact with you.

• 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 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.

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