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2025 EUTF Member Guide [PDF]
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75/25 PPO flyer [PDF]

2025 - 2026 plan summary

Benefits shown are for services received from an in-network provider.

Need help in choosing a plan?

Top Things to Consider with HMSA video thumbnail Top Things to Consider with HMSA 
PPO vs. HMO with HMSA video thumbnail PPO vs. HMO with HMSA 

Not sure what plan is right for you? Find out!

Is this plan right for you?

HMO Plan

This plan gives you access to our health maintenance organization (HMO) network. You’ll choose a health center and primary care provider to coordinate all your care.

90/10 PPO Plan

This plan pays for 90 percent of most health care costs after the deductible is met. You’ll pay the remaining 10 percent.

80/20 PPO Plan

This plan pays for 80 percent of most health care costs after the deductible is met. You’ll pay the remaining 20 percent.

75/25 PPO Plan

This plan pays for 75 percent of most health care costs after the deductible is met. You’ll pay the remaining 25 percent.

Annual deductible
None

Annual deductible

In-network:
None

Out of network:
$100 per person
$300 maximum per family

Annual deductible

In-network:
None

Out of network:
$250 per person
$750 maximum per family

Annual deductible
$300 per person
$900 maximum per family

Annual Out-of-pocket Maximum

$1,500 per person
$3,000 maximum per family

Annual Out-of-pocket Maximum

$2,000 per person
$4,000 maximum per family

Annual Out-of-pocket Maximum

$2,500 per person
$5,000 maximum per family

Annual Out-of-pocket Maximum

$5,000 per person
$10,000 maximum per family

Plan Benefits

Annual Preventive Health Evaluation:

$0

Office Visits

$15

You pay $0 for these services:

  • Hospital Room and Board
  • Maternity Care
  • Diagnostic Tests
  • Outpatient Laboratory

Surgical Procedures (outpatient surgery)

$0 (outpatient surgical center)

$15 (professional charges)

Outpatient X-ray and Other Radiology

$15 per X-ray

Emergency Room

$100

Ambulance (ground)

20%

Hearing aids

One hearing aid per ear every 60 months

20%

Plan Benefits

Annual Preventive Health Evaluation:

$0

You pay 10% of costs for these services:

  • Office Visits
  • Hospital Room and Board
  • Maternity Care
  • Surgical Procedures (outpatient surgery)
  • Diagnostic Tests
  • Outpatient Laboratory
  • Outpatient X-ray and Other Radiology
  • Emergency Room
  • Ambulance (ground)
  • Hearing aids
    One hearing aid per ear every 60 months

Plan Benefits

Annual Preventive Health Evaluation:

$0

You pay 20% of costs for these services:

  • Office Visits
  • Hospital Room and Board
  • Maternity Care
  • Surgical Procedures (outpatient surgery)
  • Diagnostic Tests
  • Outpatient Laboratory
  • Outpatient X-ray and Other Radiology
  • Emergency Room
  • Ambulance (ground)
  • Hearing aids
    One hearing aid per ear every 60 months

Plan Benefits

Annual Preventive Health Evaluation:

$0

You pay 25% of costs for these services:

  • Office Visits
  • Hospital Room and Board *
  • Maternity Care *
  • Surgical Procedures (outpatient surgery) *
  • Diagnostic Tests *
  • Outpatient Laboratory
  • Outpatient X-ray and Other Radiology *
  • Emergency Room *
  • Ambulance (ground) *
  • Hearing aids
    One hearing aid per ear every 60 months *

HMO Plan

Full plan benefit details

90/10 PPO Plan

Full plan benefit details

80/20 PPO Plan

Full plan benefit details

75/25 PPO Plan

Full plan benefit details

More resources on eutf.hawaii.gov

Every plan includes:

Annual preventive health evaluation

This important preventive care visit includes:

  • A health assessment
  • A review of your health history
  • Discussion of health risks
  • Review of prior screening test results
  • Additional screenings
What’s the copayment or coinsurance?
$0 for PPO and HMO plans

Chiropractic services

Chiropractic services from an ASH in-network provider:

  • $15 per visit
  • 20 medically necessary visits per calendar year

How to choose a chiropractor [PDF]17

Questions on chiropractic benefits?

Call for questions about your chiropractic benefits or to find a participating ASH Group network provider.

ASH Group Customer Service:
1-888-981-2746 toll-free

Monday - Friday:
2 a.m. to 5 p.m. HST

Out-of-pocket maximum

The out-of-pocket maximum is the most you'll have to pay per calendar year for covered health care services. Once you reach this amount, your plan pays 100 percent of the allowed amount for covered services excluding taxes.

There's a maximum for each person on the plan and a maximum for everyone on the plan.

Out of network

Providers in our network agree to charge set rates for services or products.

Providers who aren't in our network are called out-of-network providers. It usually costs more to see these providers because they don't have a contract with us to provide you with services at a set fee. In addition, visits to out-of-network providers may not apply to your plan's deductible.

*Annual deductible applies

HMO Plan

This plan gives you access to our health maintenance organization (HMO) network. You’ll choose a health center and primary care provider to coordinate all your care.

Annual deductible

None

Annual Out-of-pocket Maximum

$1,500 per person
$3,000 maximum per family

Plan Benefits


Annual Preventive Health Evaluation:
$0

Office Visits
$15

You pay $0 for these services:
  • Hospital Room and Board
  • Maternity Care
  • Diagnostic Tests
  • Outpatient Laboratory
Surgical Procedures (outpatient surgery)
$0 (outpatient surgical center)
$15 (professional charges)

Outpatient X-ray and Other Radiology
$15 per X-ray

Emergency Room
$100

Ambulance (ground)
20%

Hearing aids
One hearing aid per ear every 60 months
20%

Full plan benefit details

90/10 PPO Plan

This plan pays for 90 percent of most health care costs after the deductible is met. You’ll pay the remaining 10 percent.

Annual deductible

In-network:
None

Out of network:
$100 per person
$300 maximum per family

Annual Out-of-pocket Maximum

$2,000 per person
$4,000 maximum per family

Plan Benefits


Annual Preventive Health Evaluation:
$0

You pay 10% of costs for these services:
  • Office Visits
  • Hospital Room and Board
  • Maternity Care
  • Surgical Procedures (outpatient surgery)
  • Diagnostic Tests
  • Outpatient Laboratory
  • Outpatient X-ray and Other Radiology
  • Emergency Room
  • Ambulance (ground)
  • Hearing aids
    One hearing aid per ear every 60 months
Full plan benefit details

80/20 PPO Plan

This plan pays for 80 percent of most health care costs after the deductible is met. You’ll pay the remaining 20 percent.

Annual deductible

In-network:
None

Out of network:
$250 per person
$750 maximum per family

Annual Out-of-pocket Maximum

$2,500 per person
$5,000 maximum per family

Plan Benefits


Annual Preventive Health Evaluation:
$0

You pay 20% of costs for these services:
  • Office Visits
  • Hospital Room and Board
  • Maternity Care
  • Surgical Procedures (outpatient surgery)
  • Diagnostic Tests
  • Outpatient Laboratory
  • Outpatient X-ray and Other Radiology
  • Emergency Room
  • Ambulance (ground)
  • Hearing aids
    One hearing aid per ear every 60 months
Full plan benefit details

75/25 PPO Plan

This plan pays for 75 percent of most health care costs after the deductible is met. You’ll pay the remaining 25 percent.

Annual deductible

$300 per person
$900 maximum per family

Annual Out-of-pocket Maximum

$5,000 per person
$10,000 maximum per family

Plan Benefits


Annual Preventive Health Evaluation:
$0

You pay 25% of costs for these services:
  • Office Visits
  • Hospital Room and Board *
  • Maternity Care *
  • Surgical Procedures (outpatient surgery) *
  • Diagnostic Tests *
  • Outpatient Laboratory
  • Outpatient X-ray and Other Radiology *
  • Emergency Room *
  • Ambulance (ground) *
  • Hearing aids
    One hearing aid per ear every 60 months *
Full plan benefit details

More resources on eutf.hawaii.gov

Reference Guide [PDF]18

Plan forms15

Rate information19

Every plan includes:

Annual preventive health evaluation

This important preventive care visit includes:

  • A health assessment
  • A review of your health history
  • Discussion of health risks
  • Review of prior screening test results
  • Additional screenings
What’s the copayment or coinsurance?
$0 for PPO and HMO plans

Chiropractic services

Chiropractic services from an ASH in-network provider:

  • $15 per visit
  • 20 medically necessary visits per calendar year

How to choose a chiropractor [PDF]17

Questions on chiropractic benefits?

Call for questions about your chiropractic benefits or to find a participating ASH Group network provider.

ASH Group Customer Service:
1-888-981-2746 toll-free

Monday - Friday:
2 a.m. to 5 p.m. HST

*Annual deductible applies

Show me an example

Compare plans based on estimated benefits. Choose from three examples.

Simple fracture
Managing type 2 diabetes
Maternity care

2024 Guide to Benefits

P000610

By phone:

Monday – Friday: 7 a.m.-7 p.m.
Saturday: 9 a.m.-1 p.m.
808-948-6499
1-800-776-4672

By email:

I have a question

Managing type 2 diabetes Example

A year of routine in-network care of a well-controlled condition

Services included in example event

  • Primary care physician office visits (including disease education)
  • Diagnostic tests (blood work)
  • Prescription drugs
  • Durable medical equipment (glucose meter)

EXAMPLE Managing type 2 diabetes cost: $7,400

Plan HMO* 90/10 PPO 80/20 PPO 75/25 PPO
You pay deductible: $0 $0 $0 $300
Copayments: $600 $500 $500 $500
Coinsurance: $400 $300 $600 $700
What isn’t covered (Limits or exclusions): $60 $60 $60 $60
HMSA pays: $6,240 $6,540 $6,240 $5,840
Your total out-of-pocket: $1,160 $860 $1,160 $1,560
HMO*
Plan HMO*
You pay deductible: $0
Copayments: $600
Coinsurance: $400
What isn't covered (Limits or exclusions): $60
HMSA pays: $6,240
Your total out-of-pocket: $1,160
90/10 PPO
Plan 90/10 PPO
You pay deductible: $0
Copayments: $500
Coinsurance: $300
What isn't covered (Limits or exclusions): $60
HMSA pays: $6,540
Your total out-of-pocket: $860
80/20 PPO
Plan 80/20 PPO
You pay deductible: $0
Copayments: $500
Coinsurance: $600
What isn't covered (Limits or exclusions): $60
HMSA pays: $6,240
Your total out-of-pocket: $1,160
75/25 PPO
Plan 75/25 PPO
You pay deductible: $300
Copayments: $500
Coinsurance: $700
What isn't covered (Limits or exclusions): $60
HMSA pays: $5,840
Your total out-of-pocket: $1,560

This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors.

* In an HMO plan, you select a PCP and health center from the plan's network. All the care that you receive must be provided or arranged by your PCP except for emergency care, HMSA's Online Care®, vision exams, gynecological exams, and mental health and substance abuse treatment.

Simple fracture Example

In-network emergency room visit and follow up care

Services included in example event

  • Emergency room care (including medical supplies)
  • Diagnostic test (x-ray)
  • Durable medical equipment (crutches)
  • Rehabilitation services (physical therapy)

EXAMPLE Simple fracture cost: $1,900

Plan HMO* 90/10 PPO 80/20 PPO 75/25 PPO
You pay deductible: $0 $0 $0 $300
Copayments: $100 $0 $0 $0
Coinsurance: $200 $200 $400 $500
What isn’t covered (Limits or exclusions): $0 $0 $0 $0
HMSA pays: $1,600 $1,700 $1,500 $1,100
Your total out-of-pocket: $300 $200 $400 $800
HMO*
Plan HMO*
You pay deductible: $0
Copayments: $100
Coinsurance: $200
What isn't covered (Limits or exclusions): $0
HMSA pays: $1,600
Your total out-of-pocket: $300
90/10 PPO
Plan 90/10 PPO
You pay deductible: $0
Copayments: $0
Coinsurance: $200
What isn't covered (Limits or exclusions): $0
HMSA pays: $1,700
Your total out-of-pocket: $200
80/20 PPO
Plan 80/20 PPO
You pay deductible: $0
Copayments: $0
Coinsurance: $400
What isn't covered (Limits or exclusions): $0
HMSA pays: $1,500
Your total out-of-pocket: $400
75/25 PPO
Plan 75/25 PPO
You pay deductible: $300
Copayments: $0
Coinsurance: $500
What isn't covered (Limits or exclusions): $0
HMSA pays: $1,100
Your total out-of-pocket: $800

This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors.

* In an HMO plan, you select a PCP and health center from the plan's network. All the care that you receive must be provided or arranged by your PCP except for emergency care, HMSA's Online Care®, vision exams, gynecological exams, and mental health and substance abuse treatment.

Maternity Care Example

9 months of in-network pre-natal care and a routine hospital delivery

Services included in example event

  • Specialist office visits (prenatal care)
  • Childbirth/delivery professional services
  • Childbirth/delivery facility services
  • Diagnostic tests (ultrasounds and blood work)
  • Specialist visit (anesthesia)

EXAMPLE Maternity Care cost: $12,800

Plan HMO* 90/10 PPO 80/20 PPO 75/25 PPO
You pay deductible: $0 $0 $0 $300
Copayments: $100 $20 $0 $50
Coinsurance: $0 $1,300 $2,500 $3,100
What isn’t covered (Limits or exclusions): $60 $60 $60 $60
HMSA pays: $12,640 $11,420 $10,240 $9,290
Your total out-of-pocket: $160 $1,380 $2,560 $3,510
HMO*
Plan HMO*
You pay deductible: $0
Copayments: $100
Coinsurance: $0
What isn't covered (Limits or exclusions): $60
HMSA pays: $12,640
Your total out-of-pocket: $160
90/10 PPO
Plan 90/10 PPO
You pay deductible: $0
Copayments: $20
Coinsurance: $1,300
What isn't covered (Limits or exclusions): $60
HMSA pays: $11,420
Your total out-of-pocket: $1,380
80/20 PPO
Plan 80/20 PPO
You pay deductible: $0
Copayments: $0
Coinsurance: $2,500
What isn't covered (Limits or exclusions): $60
HMSA pays: $10,240
Your total out-of-pocket: $2,560
75/25 PPO
Plan 75/25 PPO
You pay deductible: $300
Copayments: $50
Coinsurance: $3,100
What isn't covered (Limits or exclusions): $60
HMSA pays: $9,290
Your total out-of-pocket: $3,510

This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors.

* In an HMO plan, you select a PCP and health center from the plan's network. All the care that you receive must be provided or arranged by your PCP except for emergency care, HMSA's Online Care®, vision exams, gynecological exams, and mental health and substance abuse treatment.

Annual deductible

A deductible is the fixed dollar amount you must pay each calendar year for certain services and products before your health plan pays.

HMO plan

This plan doesn't have a deductible. This means you pay your share of health care costs from the start of the calendar year.

For example, you become ill and require ground ambulance transportation to the hospital. The eligible charge is $350. You don’t have a deductible to meet, so you will pay your portion (20%) of the eligible charge.

Plan HMO Plan
Ground ambulance transportation: $350
Deductible: None
Benefit - HMSA pays 80%: $280
You pay 20%: $70
Total out-of-pocket cost: $70

Annual deductible

A deductible is the fixed dollar amount you must pay each calendar year for certain services and products1 before your health plan pays.

75/25 plan

The 75/25 PPO plan has an annual deductible of $300 per person and $900 per family. This means you need to pay the first $300 for covered services on a claim by claim basis before your health plan pays.

For example, you fall down the stairs and are prescribed outpatient physical therapy. The eligible charge* for the covered sessions is $250. You are responsible for the entire amount.

Later that calendar year, you become ill and require ground ambulance transportation to the hospital. The eligible charge is $350. You owe $50 to meet the remaining deductible balance, plus $75 copayment (25% of the remaining $300 balance). For the remainder of the calendar year, you will pay no deductible.

Plan 75/25 PPO Plan
Physical Therapy: $250
You pay deductible: $250 ($50 balance remaining on deductible)
Ground ambulance transportation: $350
You pay deductible: $50 ($300 deductible met)
Benefit - HMSA pays 75%: $225
You pay 25%: $75 (25% of $300)
Total out-of-pocket cost: $375

1 The deductible doesn't apply to services such as preventive care, in-network primary care office visits, in-network specialist office visits, and in-network outpatient laboratory and pathology services.

*Eligible charge does not include excise or other tax. You are responsible for all taxes related to the medical care you receive.

Annual deductible

A deductible is the fixed dollar amount you must pay each calendar year for certain services and products before your health plan pays.

80/20 plan

This plan doesn't have a deductible when you see an in-network provider. This means when you see an in-network provider, you pay your share of health care costs from the start of the calendar year.

For example, you become ill and require ground ambulance transportation to the hospital. The eligible charge* is $350. You don’t have a deductible to meet, so you will pay your portion (20%) of the eligible charge.

Plan 80/20 PPO Plan
Ground ambulance transportation: $350
Deductible: None
Benefit - HMSA pays 80%: $280
You pay 20%: $70
Total out-of-pocket cost: $70

*Eligible charge does not include excise or other tax. You are responsible for all taxes related to the medical care you receive.

Annual deductible

A deductible is the fixed dollar amount you must pay each calendar year for certain services and products before your health plan pays.

90/10 plan

This plan doesn't have a deductible when you see an in-network provider. This means when you see an in-network provider, you pay your share of health care costs from the start of the plan year.

For example, you become ill and require ground ambulance transportation to the hospital. The eligible charge* is $350. You don’t have a deductible to meet, so you will pay your portion (10%) of the eligible charge.

Plan 90/10 PPO Plan
Ground ambulance transportation: $350
Deductible: None
Benefit - HMSA pays 90%: $315
You pay 10%: $35
Total out-of-pocket cost: $35

*Eligible charge does not include excise or other tax. You are responsible for all taxes related to the medical care you receive.

Which plan is right for you?

Here are a few things you may want to consider when choosing a plan.

Cost

Find a plan that fits your budget.

Doctors

See which type of provider network is right for you.

Risk

Decide what level of protection you need.

Cost

The total cost of your health insurance depends on your plan's premiums and out-of-pocket costs. Knowing how these work and what you're paying for can help make sure you’re not spending more than you need to.

Premiums are the payments you make for your health plan. You may pay the entire premium or just the part not covered by your employer, usually monthly.

When seeing a doctor, plans either mention a copayment or coinsurance, which is the amount you pay for covered services. The cap on your out-of-pocket costs is your out-of-pocket maximum.

I'd like to...

Keep premiums low Keep out-of-pocket costs low
Back

Doctors

When you’re choosing a health plan, one of the main things to consider is the plan’s network of doctors. Each health plan has a group of doctors who have an agreement with the health plan to charge a set amount for services. It’s best to see providers in our network to get the best value.

There are two types of plans with different doctor networks, preferred provider organization (PPO) and health maintenance organization (HMO) plans.

PPO plans let you see any provider you prefer in HMSA’s network of participating providers. PPO plans work best for people who value the freedom to choose.

HMO plans require you to pick one health center and a primary care provider (PCP) in that health center to provide or arrange your care. Your PCP will refer you to specialists and other health care providers in your health center when you need it.

I'd like to...

Have the freedom to choose your doctor Choose a health center
Back

Risk

Manage your financial risk against a major health event through a plan’s annual out-of-pocket max.

The out-of-pocket maximum is the most you will have to pay for covered health services per calendar year. In the case of a major health event, where your out-of-pocket costs may amount to a number larger than you can handle, an out-of-pocket max is an important safeguard for you and your family.

The lower a plan's out-of-pocket maximum, the lower your financial risk for the calendar year. However, you'll usually pay higher premiums for more financial protection.

I'd like to...

Have financial protection from high health care costs Have lower premiums
Back

Because you told us that you would like to keep premiums low, keep out-of-pockets costs low, have the freedom to choose your doctor choose a health center and have financial protection from high health care costs have lower premiums , you may want to consider the following plans:

If a plan meets your criteria, up to three badges will display under the plan name.