Find information about specific benefits, ranging from preventive care to surgery or diagnostic lab services.
Benefits shown are for services received from an in-network provider.
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CompMED with Prescription Drug |
Health Plan Hawaii (HPH) with Prescription Drug |
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Annual deductible |
Annual deductible |
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Annual Out-of-pocket Maximum |
Annual Out-of-pocket Maximum |
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Find a doctor1 |
Find a doctor1 |
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Plan BenefitsAnnual Preventive Health Evaluation $0
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Plan BenefitsAnnual Preventive Health Evaluation $0 Office Visits $20 Maternity Care** $0 Emergency Room $25 Hospital Room and Board $75 per day Surgical Procedures (outpatient surgery) $0 (outpatient surgical center) $20 (professional charges) Diagnostic Tests $20 Outpatient X-ray and Other Radiology $20 per X-ray Ambulance (ground) $0 |
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| Full plan benefit details |
Full plan benefit details |
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Every plan includes: |
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Annual physical exam |
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*A service dollar maximum may apply. You may owe amounts in addition to your copayment. Refer to your Guide to Benefits for details.
** Routine Prenatal Visits, Delivery and Postpartum Visit
$3,000 per person
$9,000 maximum per family
Find a doctor1
Choose from more than 5,000 doctors and specialists close to where you live or work.
Find a doctor1
Choose from more than 5,000 doctors and specialists close to where you live or work.
A year of routine in-network care of a well-controlled condition
Services included in example event
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 |
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.
In-network emergency room visit and follow up care
Services included in example event
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 |
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.
9 months of in-network pre-natal care and a routine hospital delivery
Services included in example event
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 |
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.
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.
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.
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 |
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.
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.
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.