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• Organization Determination (Request for Prior Authorization)

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

• ACA Plan Resources

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

• Payment Determination Criteria

  HMSA applies payment determination criteria to determine if a service or supply is covered by your plan.

• Essential, Optimal, and Metallic Formulary Coverage Determination Request

  Need a prescription drug that’s not on your formulary? Get instructions on how to start the request process with your doctor.

• Durable Medical Equipment: Renting, Buying, and Buying Online

  Most HMSA plans cover durable medical equipment such as hospital beds, wheelchairs, and insulin pumps.

• Durable Medical Equipment

  HMSA covers renting and purchasing durable medical equipment. Learn how the process works and what you need to do.

• 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.

• Physical and Occupational Therapy Benefits

  Physical therapy treats disease or injury using therapeutic exercises and other interventions to restore range of motion, improve posture and strength, and more.