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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.

• How to Appeal an HMSA Decision as a Commercial Member

  An appeal is a formal way of asking HMSA to review a decision on a denied claim. Learn more about the process.

• Submitting a Precertification Request

  Learn the steps you need to take to submit a precertification request by yourself or through a provider.

• 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.

• 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.

• 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.

• 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.