Active Employees Retirees Part-time & Temporary Employees HSTA VB

Active Employees

Available 2018 plans

See the details of your plan, including what you’ll pay when you go to the doctor or hospital.

Open enrollment for EUTF members is April 2–30.

Happy with your HMSA plan? You don’t have to do anything to keep it.

Looking for an HMSA plan? Now’s the time to join.

Questions? Attend an open enrollment session with an HMSA health plan adviser. They’ll be happy to explain our health plans and answer your questions. View session schedule.

Actives OE Brochure
2018 plan brochure

Summary of all plans

Download
Actives Presentation
2018 presentation

Presentation for open enrollment.

Download
Actives Presentation
75/25 PPO flier

Basics about the 75/25 plan

Download

2018 plan summary

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

  90/10 PPO Plan 80/20 PPO Plan 75/25 PPO Plan HMO Plan
Annual deductible In network: none
Out of network:
$100 per person
$300 per family
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 $0
Maternity care 10% 20% 25%* None
Surgical procedures 10% 20% 25%* None (outpatient surgical center)
$15 (professional charges)
Diagnostic tests 10% 20% 25%* $0
Outpatient laboratory 10% 20% 25% Effective 7/1/18 $0
Outpatient X-ray and other radiology 10% 20% 25%* $15 per X-ray
Emergency room 10% 20% 25%* $100
Ambulance 10% 20% 25%* 20%
Chiropractic services from an ASH in-network provider New! Effective 7/1/2018 $15 per visit $15 per visit $15 per visit $15 per visit
Reference guide Download Download Download Download
Chiropractic services Guide to Benefits Download Download Download Download
Guide to Benefits Download Download Download Download
Plan forms Enrollment Enrollment Enrollment Enrollment

90/10 PPO Plan

Annual deductible

In network:
none
Out of network:
$100 per person
$300 per family

Annual out-of-pocket max

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

Services (You Pay)

Office visits
10%

Physical exams
$0

Hospital room and board
10%

Surgical procedures
10%

Diagnostic tests
10%

Outpatient laboratory
10%

Outpatient X-ray and other radiology
10%

Emergency room
10%

Ambulance
10%

Chiropractic services from an ASH in-network provider New! Effective 7/1/2018
$15 per visit

Reference guide
Download

Chiropractic services Guide to Benefits
Download

Guide to Benefits
Download

Plan forms
Enrollment

80/20 PPO Plan

Annual deductible

In network:
none
Out of network:
$250 per person
$750 per family

Annual out-of-pocket max

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

Services (You Pay)

Office visits
20%

Physical exams
$0

Hospital room and board
20%

Surgical procedures
20%

Diagnostic tests
20%

Outpatient laboratory
20%

Outpatient X-ray and other radiology
20%

Emergency room
20%

Ambulance
20%

Chiropractic services from an ASH in-network provider New! Effective 7/1/2018
$15 per visit

Reference guide
Download

Chiropractic services Guide to Benefits
Download

Guide to Benefits
Download

Plan forms
Enrollment

75/25 PPO Plan

Annual deductible

$300 per person
Maximum: $900 per family

Annual out-of-pocket max

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

Services (You Pay)

Office visits
25%

Physical exams
$0

Hospital room and board
25%*

Surgical procedures
25%*

Diagnostic tests
25%*

Outpatient laboratory
25% Effective 7/1/18

Outpatient X-ray and other radiology
25%*

Emergency room
25%*

Ambulance
25%*

Chiropractic services from an ASH in-network provider New! Effective 7/1/2018
$15 per visit

Reference guide
Download

Chiropractic services Guide to Benefits
Download

Guide to Benefits
Download

Plan forms
Enrollment

HMO Plan

Annual deductible

None

Annual out-of-pocket max

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

Services (You Pay)

Office visits
$15

Physical exams
$15

Hospital room and board
$0

Surgical procedures
None (outpatient surgical center) $15 (professional charges)

Diagnostic tests
$0

Outpatient laboratory
$0

Outpatient X-ray and other radiology
$15 per X-ray

Emergency room
$100

Ambulance
20%

Chiropractic services from an ASH in-network provider New! Effective 7/1/2018
$15 per visit

Reference guide
Download

Chiropractic services Guide to Benefits
Download

Guide to Benefits
Download

Plan forms
Enrollment

*Annual deductible applies

Questions?

We’re happy to help.

Contact us
Annual physical exam
This important preventive care visit includes:
  • Routine vision and hearing tests
  • Audiogram (optional)
  • Blood count
  • Chest X-ray
  • Biochemistry panel and electrocardiogram (for ages 40 and up)
What’s the copayment?
$0 for PPO, HMO, and retiree plans

By phone:

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

In person:

HMSA EUTF Office
City Financial Tower
201 Merchant St., Suite 1840
Monday - Friday: 7:45 a.m. - 4:30 p.m.