HMSA: Everywhere You Need Us

With HMSA, state and county workers can choose the best doctors and hospitals, get care when and where they need it, and travel without worry.

Discover why 700k people choose HMSA

Health plans

Click the tab that applies to you to learn more about HMSA’s health plans and benefits.

2016 plan summary

  90/10 PPO Plan 80/20 PPO Plan 75/25 PPO Plan HMO Plan
Annual deductible None In network: none
Out of network:
$250 per person
$750 per family
$300 per person
Maximum: $900 per family
None
Annual out-of-pocket max $2,000 per person
$4,000 per family
$2,500 per person
$5,000 per family
$5,000 per person
$10,000 per family
$1,500 per person
$3,000 per family
Services You Pay You Pay You Pay You Pay
Office visits 10% 20% 25% $15
Physical exams $0 $0 $0 $15
Hospital room and board 10% 20% 25%* $0
Surgical procedures 10% 20% 25%* Nothing for outpatient surgical center. $15 for professional charges.
Diagnostic tests 10% 20% 25% $0
Emergency room 10% 20% 25%* $25
Ambulance 10% 20% 25%* 20%
Reference guide Download Download Download Download
Guide to Benefits Download Download Download Download
Plan forms Enrollment Enrollment Enrollment Enrollment

*Annual deductible applies

Need help choosing a plan?

Learn about a PPO vs. an HMO

See if your doctor is part of HMSA's network:
PPO plans | HMO plan

Find out what you get with your plan
Compare your old plan to our 2016 plans

Open Enrollment resources

Oahu

Neighbor Islands

Available 2017 plans

2017 open enrollment for active EUTF retirees is October 10-31.

If you’re happy with your plan, you don’t need to do anything to keep it. If you need to make changes to your plan or enroll, you must do so by October 31 to get covered from January 1 – December 31, 2017. If you have questions about plan benefits, attend an HMSA information session.

2017 plan brochure
2017 open enrollment presentation

2017 plan summary

  EUTF Retiree Plan
Annual deductible $100 per person
$300 per family
Annual out-of-pocket max $2,500 per person
$7,500 per family
Services You Pay
Office visits 10%
Physical exams $0
Hospital room and board 10%*
Surgical procedures 10% (cutting)
20% (noncutting)
Diagnostic tests 10% (inpatient)
20% (outpatient)
Emergency room 10%
Ambulance 20%
Guide to Benefits With Medicare - 2017
With Medicare - 2016
Without Medicare - 2017
Without Medicare - 2016
Plan forms Enrollment

*Annual deductible applies

2016 plan summary

  75/25 PPO Plan
Annual deductible $300 per person
$900 per family
Annual out-of-pocket max $5,000 per person
$13,200 per family
Services You Pay
Office visits 25%
Physical exams $0
Hospital room and board 25%*
Surgical procedures 25%*
Diagnostic tests 25%*
Emergency room 25%*
Ambulance 25%*
Guide to Benefits Download
Plan forms Application

*Annual deductible applies

Need help choosing a plan?

Learn about a PPO vs. an HMO
See if your doctor is part of HMSA's network
Find out what you get with your plan

  Monthly Premium
Self only $858.80
Two-party $1,444.04
Family $2,029.32

How to Apply

Mail the completed form and your first month's premium to:
HMSA 8-AMS
P.O. Box 860
Honolulu, HI 96808

Please make checks payable to HMSA.

Although these plans are still active, they're closed to new members. For more information, go to eutf.hawaii.gov.

  Active Employee Plans Retiree Plan
  90/10 PPO Plan 80/20 PPO Plan 90/10 PPO Plan
Annual deductible $100 per person
$300 per family
$100 per person
$300 per family
None
Annual out-of-pocket max $2,000 per person
$4,000 per family
$2,500 per person
$5,000 per family
$2,000 per person
$6,000 per family
Services You Pay You Pay You Pay
Office visits 10% 20% 10%
Physical exams $0 $0 $0 up to
  • $90 ages 7-12
  • $115 ages 13-18
  • $180 ages 19-39
  • $245 ages 40+
Hospital room and board 10% 20% 10%
Surgical procedures 10% 20% 10%
Diagnostic tests 10% 20% 10%
Emergency room 10% 20% 10%
Ambulance 10% 20% 10%
Guide to Benefits: 2016 Download Download Download
Plan forms Enrollment Enrollment Enrollment

2015 Guide to Benefits

Already an HMSA member?

Explore the tools and resources that come with your HMSA health plan. We can give you the support you need to improve your health and well-being.

My Account

View plan benefits and claims, access well-being apps, change personal information, and more.

Member Resources

Learn about health plans, health insurance, and how to get the most out of your health plan.

Well-being

Boost well-being with workshops, programs, health coaching, and more.
View brochure

FAQs

What plan do I have?

Find the coverage code on the back of your HMSA membership card. Then use this table to see which plan you have:

Your Coverage Code Your HMSA Plan
Medical 562 90/10 PPO Plan
690 80/20 PPO Plan
852 75/25 PPO Plan
XG HMO Plan
667 EUTF Retiree Plan without Medicare
563 EUTF Retiree Plan with Medicare
823 HSTA VB 90/10 PPO Plan
693 HSTA VB 80/20 PPO Plan
668 HSTA VB Retiree PPP Plan

Am I covered when I travel?

Yes! You can see Blue Cross and Blue Shield doctors on the U.S. Mainland and in more than 200 countries and territories around the world. If you’re planning a trip, call HMSA at 808-948-6499 to find out what your health plan covers and where to go for medical care while traveling.

How do I add or remove my dependent from my plan?

Submit a request for enrollment, termination, or other changes to your designated EUTF personnel officer. If you’re a DOE employee, submit your request to the DOE-HBAU office. You can also email your inquiry to eutf@hawaii.gov or call the EUTF Customer Service Call Center at 808-586-7390 or 1-800-295-0089 toll-free.

What’s the difference between HMSA’s PPO plans?

The numbers in the plan name tell you what percent of eligible charges HMSA pays for most network services and the amount the employee is responsible for.

  HMSA Pays You Pay
90/10 PPO Plan 90% 10%
80/20 PPO Plan 80% 20%
75/25 PPO Plan 75% 25%

Can I still cover my kids?

Yes, you can cover your children by birth, marriage (stepchild), adoption, or placement for adoption up to age 26. If you have a child who’s turning 26 soon, check with the EUTF and HMSA respectively to see if your child is eligible to enroll in the EUTF COBRA plan or an HMSA individual plan.

If your child isn’t married and isn’t self-sufficient because of a mental or physical incapacity that existed before age 19, you can continue to cover that child regardless of age.

Why is my premium higher this year? Can I change my plan?

Many factors contribute to higher premiums, including poor health, the aging population, brand-name drugs, and over-used medical services. You can change your plan during open enrollment or when you have a qualifying event such as getting married or enrolling a newborn.

Are eyeglasses covered?

Eyeglasses are covered through your vision plan carrier, Vision Service Plan (VSP). If you have certain medical conditions, HMSA will pay for “vision appliances,” which include eyeglasses and contact lenses. This benefit is subject to special limits. Call us at 808-948-6499 for details.

How do I take the Gallup-Healthways Well-Being 5™ survey?

  • Go to hmsa.com/wellbeing and scroll to the “See where you are” section.
  • Click the “Member” button and log into My Account.
    • If you don’t have a My Account, click “Create an account” to register using your HMSA membership card and a valid email address. If you have multiple HMSA medical plans, use your primary one to register.
  • Click “Get started” under the “Live Well for What Matters” section to take the survey.