HMSA Plans

HMSA offers a variety of medical plans to its employer groups. When providing services to members of these plans, participating providers agree to accept HMSA's eligible charge as payment in full for their services.

HMSA Medical Plans:

• Fee-for-Service Plans
• Preferred Provider Plan - A medical plan that combines the benefits of basic medical coverage and comprehensive major medical coverage in a single plan. When a member has services performed by a participating provider, the amount of the member's copayment generally will be less than it would be if the services were performed by a nonparticipating provider.
• Comprehensive Medical Plan - A medical plan that combines the benefits of basic medical coverage and comprehensive major medical coverage in a single plan. Copayments for services rendered by both participating and nonparticipating providers are the same.
• Blue Cross and Blue Shield's Federal Employee Program (FEP) -  A national Blue Cross and Blue Shield program serving both the Federal Employees Health Benefits (FEHB) program and the Postal Service Health Benefits (PSHB) program. Refer to Federal Employee Program (FEP) for more information.
• HMSA's Federal Plan (87) - A medical plan that combines the benefits of basic medical coverage and comprehensive major medical coverage in a single plan and covers federal employees residing in Hawaii.
• HMSA Plan for Postal Service Employees - A medical plan that combines the benefits of basic medical coverage and comprehensive major medical coverage in a single plan and covers postal employees residing in Hawaii.
• Hawaii Employer-Union Health Benefits Trust Fund (EUTF) - A medical plan that combines the benefits of basic medical coverage and comprehensive major medical coverage in a single plan and covers state, city and county employees.

HMSA's Individual Plans (free choice)

• Conversion Plan II
• Individual Business Plan (free choice option)
• Individual Plan 6
• Student Plan 19

Plan benefits for these plans are similar to those of the Preferred Provider Plan.

Note: Individual plans may include deductibles and waiting periods for preexisting conditions and certain other medical conditions.

HMO Commercial Plans

HMO plan benefits include basic medical and hospital services, preventive services, therapeutic services and supplies. Referrals generally are required when the patient is referred to a physician outside of his or her health center.

• The following plans are also considered to be HMO commercial plans:
  • HMSA's Individual HMO Plans
  • HPH Conversion Plan
  • The HMSA Children's Plan

• HMSA's Individual HMO Plans
  • Individual Business Plan (HMO option)
  • Individual Care Plan
  • Conversion Plan 10
  • 50 Plus

Plan benefits for these plans are similar to those of other HMO plans.

Note: Individual Plans may include waiting periods for preexisting conditions and certain other medical conditions.

HPH Conversion Plan - For HMSA group members converting to individual coverage who previously were covered by Health Plan Hawaii.

The HMSA Children's Plan - This is an individual plan designed to provide affordable medical care to children age 31 days through 18 years who do not have access to healthcare insurance.

Other Affiliated Plans

• BlueCard Plans - Members of all Blue Cross and Blue Shield plans nationwide should be treated as though they were HMSA members. Providers can identify Blue Cross and Blue Shield plan members by looking for the Blue Cross and Blue Shield service marks in the upper left hand corner of the member's ID card. See BlueCard Program for more information.

Rider

In addition, eligible charge requirements also apply to the following rider:

• Prescription Drug Riders - A supplemental rider that provides coverage for prescription drugs provided by a pharmacist or a dispensing physician. Dispensing physicians agree to accept HMSA's eligible charge and may not charge the member more than his or her designated copayment.

Separate Contracting

Providers may separately contract with HMSA to provide services to members of the following plans:

• Senior Connection - A Medicare supplemental plan.
• The HMSA Plan for QUEST Members - A managed care plan sponsored by the state Department of Human Services (DHS) and administered by HMSA.
• Medicare Advantage Plans
  • Complete
  • Completed Plus
  • Standard
  • Standard Plus
  • Essential Advantage (HMO)

Revision History