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• ACA Plan Resources

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

• 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.

• Durable Medical Equipment

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

• 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.

• Submitting a Precertification Request

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

• HMSA Medicare Advantage Coverage Determination Request

  Fill out this form if you have Medicare Part D and want to know if HMSA will cover a prescription drug and how much it will cost you.

• Organization Determination (Request for Prior Authorization)

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

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