Pediatric dental benefits are required by the ACA. Although our medical plans don’t include pediatric dental benefits, you may choose an HMSA dental plan to get covered.
| Plan | Deductible | Max out– of–pocket | Coinsurance | Doctor visit copayment | Specialist visit copayment |
Premiums based on age: |
|
|---|---|---|---|---|---|---|---|
| Platinum PPO |
Prescription drugs (30-day supply)
Additional benefits
Fitness membership Plan resources
Summary of Benefits Coverage |
$0 | $6,000 | 10% - 20% 5 | $20 | $20 | $216.81 / month $341.43 / month $341.43 / month $341.43 / month $341.43 / month $342.80 / month $349.63 / month $357.82 / month $371.14 / month $382.06 / month $387.52 / month $395.72 / month $403.91 / month $409.03 / month $414.50 / month $417.23 / month $419.96 / month $422.69 / month $425.42 / month $430.89 / month $436.35 / month $444.54 / month $452.40 / month $463.32 / month $476.98 / month $493.03 / month $512.15 / month $533.66 / month $558.24 / month $582.48 / month $609.80 / month $636.77 / month $666.47 / month $696.52 / month $728.96 / month $761.39 / month $796.56 / month $832.07 / month $869.97 / month $888.75 / month $926.65 / month $959.42 / month $980.93 / month $1,007.91 / month $1,024.29 / month $1,024.29 / month |
| Platinum HMO |
Prescription drugs (30-day supply)
Additional benefits
Fitness membership Plan resources
Summary of Benefits Coverage |
$0 | $6,850 | 10% | $10 | $20 | $211.00 / month $332.29 / month $332.29 / month $332.29 / month $332.29 / month $333.62 / month $340.26 / month $348.24 / month $361.20 / month $371.83 / month $377.15 / month $385.12 / month $393.10 / month $398.08 / month $403.40 / month $406.06 / month $408.72 / month $411.37 / month $414.03 / month $419.35 / month $424.67 / month $432.64 / month $440.28 / month $450.92 / month $464.21 / month $479.83 / month $498.43 / month $519.37 / month $543.29 / month $566.88 / month $593.47 / month $619.72 / month $648.63 / month $677.87 / month $709.44 / month $741.00 / month $775.23 / month $809.79 / month $846.67 / month $864.95 / month $901.83 / month $933.73 / month $954.67 / month $980.92 / month $996.87 / month $996.87 / month |
| Gold PPO |
Prescription drugs (30-day supply)
Additional benefits
Fitness membership Plan resources
Summary of Benefits Coverage |
$0 | $6,850 | 30% | $30 | $30 | $183.26 / month $288.59 / month $288.59 / month $288.59 / month $288.59 / month $289.75 / month $295.52 / month $302.45 / month $313.70 / month $322.94 / month $327.55 / month $334.48 / month $341.41 / month $345.73 / month $350.35 / month $352.66 / month $354.97 / month $357.28 / month $359.59 / month $364.20 / month $368.82 / month $375.75 / month $382.39 / month $391.62 / month $403.16 / month $416.73 / month $432.89 / month $451.07 / month $471.85 / month $492.34 / month $515.43 / month $538.23 / month $563.33 / month $588.73 / month $616.15 / month $643.56 / month $673.29 / month $703.30 / month $735.33 / month $751.21 / month $783.24 / month $810.95 / month $829.13 / month $851.93 / month $865.77 / month $865.77 / month |
| Gold PPO 1000 |
Prescription drugs (30-day supply)
Additional benefits
Fitness membership Plan resources
Summary of Benefits Coverage |
$1,000 | $6,850 | 20% | $20 | $20 | $168.69 / month $265.65 / month $265.65 / month $265.65 / month $265.65 / month $266.71 / month $272.03 / month $278.40 / month $288.76 / month $297.26 / month $301.51 / month $307.89 / month $314.26 / month $318.25 / month $322.50 / month $324.62 / month $326.75 / month $328.87 / month $331.00 / month $335.25 / month $339.50 / month $345.88 / month $351.99 / month $360.49 / month $371.11 / month $383.60 / month $398.47 / month $415.21 / month $434.34 / month $453.20 / month $474.45 / month $495.44 / month $518.55 / month $541.93 / month $567.16 / month $592.40 / month $619.76 / month $647.39 / month $676.87 / month $691.49 / month $720.97 / month $746.48 / month $763.21 / month $784.20 / month $796.95 / month $796.95 / month |
| Gold HMO |
Prescription drugs (30-day supply)
Additional benefits
Fitness membership Plan resources
Summary of Benefits Coverage |
$1,000 | $6,850 | 20% | $15 | $30 | $164.79 / month $259.51 / month $259.51 / month $259.51 / month $259.51 / month $260.55 / month $265.74 / month $271.97 / month $282.09 / month $290.39 / month $294.55 / month $300.77 / month $307.00 / month $310.90 / month $315.05 / month $317.12 / month $319.20 / month $321.28 / month $323.35 / month $327.50 / month $331.66 / month $337.88 / month $343.85 / month $352.16 / month $362.54 / month $374.74 / month $389.27 / month $405.62 / month $424.30 / month $442.73 / month $463.49 / month $483.99 / month $506.57 / month $529.40 / month $554.06 / month $578.71 / month $605.44 / month $632.43 / month $661.24 / month $675.51 / month $704.32 / month $729.23 / month $745.58 / month $766.08 / month $778.53 / month $778.53 / month |
| Silver PPO 1500 |
Prescription drugs (30-day supply)
Additional benefits
Fitness membership Plan resources
Summary of Benefits Coverage |
$1,500 | $6,850 | 30% - 50% 5 | $40 | $40 | $138.99 / month $218.88 / month $218.88 / month $218.88 / month $218.88 / month $219.75 / month $224.13 / month $229.38 / month $237.92 / month $244.92 / month $248.43 / month $253.68 / month $258.93 / month $262.22 / month $265.72 / month $267.47 / month $269.22 / month $270.97 / month $272.72 / month $276.22 / month $279.73 / month $284.98 / month $290.01 / month $297.02 / month $305.77 / month $316.06 / month $328.32 / month $342.11 / month $357.87 / month $373.41 / month $390.92 / month $408.21 / month $427.25 / month $446.51 / month $467.30 / month $488.10 / month $510.64 / month $533.41 / month $557.70 / month $569.74 / month $594.03 / month $615.05 / month $628.84 / month $646.13 / month $656.64 / month $656.64 / month |
| Silver PPO 2500 |
Prescription drugs (30-day supply)
Additional benefits
Fitness membership Plan resources
Summary of Benefits Coverage |
$2,500 | $6,850 | 20% | $30 | $30 | $136.81 / month $215.45 / month $215.45 / month $215.45 / month $215.45 / month $216.31 / month $220.62 / month $225.79 / month $234.19 / month $241.08 / month $244.53 / month $249.70 / month $254.87 / month $258.10 / month $261.55 / month $263.27 / month $265.00 / month $266.72 / month $268.45 / month $271.89 / month $275.34 / month $280.51 / month $285.47 / month $292.36 / month $300.98 / month $311.10 / month $323.17 / month $336.74 / month $352.25 / month $367.55 / month $384.79 / month $401.81 / month $420.55 / month $439.51 / month $459.98 / month $480.44 / month $502.63 / month $525.04 / month $548.96 / month $560.81 / month $584.72 / month $605.40 / month $618.98 / month $636.00 / month $646.35 / month $646.35 / month |
| Silver HMO |
Prescription drugs (30-day supply)
Additional benefits
Fitness membership Plan resources
Summary of Benefits Coverage |
$2,500 | $6,850 | 30% | $20 | $40 | $129.34 / month $203.69 / month $203.69 / month $203.69 / month $203.69 / month $204.50 / month $208.58 / month $213.47 / month $221.41 / month $227.93 / month $231.19 / month $236.08 / month $240.96 / month $244.02 / month $247.28 / month $248.91 / month $250.54 / month $252.17 / month $253.80 / month $257.06 / month $260.31 / month $265.20 / month $269.89 / month $276.41 / month $284.55 / month $294.13 / month $305.53 / month $318.37 / month $333.03 / month $347.49 / month $363.79 / month $379.88 / month $397.60 / month $415.53 / month $434.88 / month $454.23 / month $475.21 / month $496.39 / month $519.00 / month $530.20 / month $552.81 / month $572.37 / month $585.20 / month $601.29 / month $611.07 / month $611.07 / month |
| Bronze PPO 6850 |
Prescription drugs (30-day supply)
Additional benefits
Fitness membership Plan resources
Summary of Benefits Coverage |
$6,850 | $6,850 | 0% | $0 1 | $0 1 | $106.22 / month $167.28 / month $167.28 / month $167.28 / month $167.28 / month $167.95 / month $171.30 / month $175.31 / month $181.84 / month $187.19 / month $189.87 / month $193.88 / month $197.90 / month $200.40 / month $203.08 / month $204.42 / month $205.76 / month $207.10 / month $208.43 / month $211.11 / month $213.79 / month $217.80 / month $221.65 / month $227.00 / month $233.69 / month $241.56 / month $250.92 / month $261.46 / month $273.51 / month $285.38 / month $298.77 / month $311.98 / month $326.54 / month $341.26 / month $357.15 / month $373.04 / month $390.27 / month $407.67 / month $426.24 / month $435.44 / month $454.01 / month $470.06 / month $480.60 / month $493.82 / month $501.84 / month $501.84 / month |
| Bronze HMO |
Prescription drugs (30-day supply)
Additional benefits
Fitness membership Plan resources
Summary of Benefits Coverage |
$5,000 | $6,850 | 40% | $30 1 | $60 1 | $98.61 / month $155.28 / month $155.28 / month $155.28 / month $155.28 / month $155.91 / month $159.01 / month $162.74 / month $168.79 / month $173.76 / month $176.25 / month $179.97 / month $183.70 / month $186.03 / month $188.52 / month $189.76 / month $191.00 / month $192.24 / month $193.48 / month $195.97 / month $198.45 / month $202.18 / month $205.75 / month $210.72 / month $216.93 / month $224.23 / month $232.93 / month $242.71 / month $253.89 / month $264.92 / month $277.34 / month $289.61 / month $303.12 / month $316.78 / month $331.53 / month $346.28 / month $362.28 / month $378.43 / month $395.67 / month $404.21 / month $421.44 / month $436.35 / month $446.13 / month $458.40 / month $465.84 / month $465.84 / month |
| Catastrophic Plan |
This is single coverage for individuals under 30 years of age OR who have a hardship exemption from healthcare.gov. Prescription drugs (30-day supply)
Additional benefitsPlan resources
Summary of Benefits Coverage |
$6,850 | $6,850 | 0% | $50 2 | $50 2 | $97.75 / month $153.93 / month $153.93 / month $153.93 / month $153.93 / month $154.55 / month $157.63 / month $161.32 / month $167.33 / month $172.25 / month $174.72 / month $178.41 / month $182.11 / month $184.41 / month $186.88 / month $188.11 / month $189.34 / month $190.57 / month $191.80 / month $194.27 / month $196.73 / month $200.42 / month $203.96 / month $208.89 / month $215.05 / month $222.28 / month $230.90 / month $240.60 / month $251.68 / month $262.61 / month $274.93 / month $287.09 / month $300.48 / month $314.03 / month $328.65 / month $343.27 / month $359.13 / month $375.14 / month $392.23 / month $400.69 / month $417.78 / month $432.56 / month $442.26 / month $454.42 / month $461.79 / month $461.79 / month |
Health benefits
These benefits are included in all HMSA individual plans and others are available when you enroll:
- HMSA’s Online Care.
- An annual physical/wellness exam with no copayment.
- Generic drug coverage*.
- Adult vision coverage.
*Generic drugs are covered before you meet the deductible, except for single-source generic drugs (drugs manufactured by a single pharmaceutical company) dispensed at a pharmacy.
Our medical plans no longer include children’s dental benefits, but you can choose an HMSA pediatric dental plan to get covered.
| Plan | Deductible | Max out– of–pocket | Coinsurance | Doctor visit copayment | Specialist visit copayment |
Premiums based on age: |
|
|---|---|---|---|---|---|---|---|
| Platinum PPO |
Prescription drugs (30-day supply)
Additional benefitsPlan resources
Summary of Benefits Coverage |
$0 | $2,500 | 10% | $20 | $173.49 / month $273.22 / month $274.31 / month $279.77 / month $286.33 / month $296.99 / month $305.73 / month $310.10 / month $316.66 / month $323.22 / month $327.31 / month $331.69 / month $333.87 / month $336.06 / month $338.24 / month $340.43 / month $344.80 / month $349.17 / month $355.73 / month $362.01 / month $370.76 / month $381.68 / month $394.52 / month $409.83 / month $427.04 / month $446.71 / month $466.11 / month $487.97 / month $509.55 / month $533.32 / month $557.36 / month $583.32 / month $609.27 / month $637.41 / month $665.83 / month $696.16 / month $711.18 / month $741.51 / month $767.74 / month $784.95 / month $806.54 / month $819.65 / month | |
| Platinum HMO |
Prescription drugs (30-day supply)
Additional benefitsPlan resources
Summary of Benefits Coverage |
$0 | $2,500 | 10% | $10 | $169.25 / month $266.54 / month $266.54 / month $267.61 / month $272.94 / month $279.33 / month $289.73 / month $298.26 / month $302.52 / month $308.92 / month $315.32 / month $319.31 / month $323.58 / month $325.71 / month $327.84 / month $329.98 / month $332.11 / month $336.37 / month $340.64 / month $347.03 / month $353.16 / month $361.69 / month $372.35 / month $384.88 / month $399.81 / month $416.60 / month $435.79 / month $454.72 / month $476.04 / month $497.10 / month $520.28 / month $543.74 / month $569.06 / month $594.38 / month $621.84 / month $649.56 / month $679.14 / month $693.80 / month $723.39 / month $748.97 / month $765.77 / month $786.82 / month $799.62 / month | |
| Gold HMO |
Prescription drugs (30-day supply)
Additional benefitsPlan resources
Summary of Benefits Coverage |
$1,000 | $4,000 | 20% | $15 | $131.84 / month $207.62 / month $208.45 / month $212.60 / month $217.58 / month $225.68 / month $232.32 / month $235.64 / month $240.63 / month $245.61 / month $248.72 / month $252.05 / month $253.71 / month $255.37 / month $257.03 / month $258.69 / month $262.01 / month $265.33 / month $270.32 / month $275.09 / month $281.73 / month $290.04 / month $299.80 / month $311.42 / month $324.50 / month $339.45 / month $354.19 / month $370.80 / month $387.20 / month $405.27 / month $423.54 / month $443.26 / month $462.98 / month $484.37 / month $505.96 / month $529.00 / month $540.42 / month $563.47 / month $583.40 / month $596.48 / month $612.88 / month $622.85 / month | |
| Gold PPO 1000 |
Prescription drugs (30-day supply)
Additional benefitsPlan resources
Summary of Benefits Coverage |
$1,000 | $4,000 | 20% | $20 | $131.84 / month $207.63 / month $208.46 / month $212.61 / month $217.59 / month $225.69 / month $232.33 / month $235.65 / month $240.64 / month $245.62 / month $248.74 / month $252.06 / month $253.72 / month $255.38 / month $257.04 / month $258.70 / month $262.02 / month $265.35 / month $270.33 / month $275.10 / month $281.75 / month $290.05 / month $299.81 / month $311.44 / month $324.52 / month $339.47 / month $354.21 / month $370.82 / month $387.22 / month $405.28 / month $423.56 / month $443.28 / month $463.00 / month $484.39 / month $505.98 / month $529.03 / month $540.45 / month $563.49 / month $583.43 / month $596.51 / month $612.91 / month $622.88 / month | |
| Gold PPO |
Prescription drugs (30-day supply)
Additional benefitsPlan resources
Summary of Benefits Coverage |
$0 | $6,600 | 30% | $30 | $141.41 / month $222.69 / month $223.58 / month $228.03 / month $233.38 / month $242.06 / month $249.19 / month $252.75 / month $258.09 / month $263.44 / month $266.78 / month $270.34 / month $272.12 / month $273.90 / month $275.69 / month $277.47 / month $281.03 / month $284.59 / month $289.94 / month $295.06 / month $302.19 / month $311.09 / month $321.56 / month $334.03 / month $348.06 / month $364.09 / month $379.90 / month $397.72 / month $415.31 / month $434.68 / month $454.28 / month $475.44 / month $496.59 / month $519.53 / month $542.69 / month $567.40 / month $579.65 / month $604.37 / month $625.75 / month $639.78 / month $657.37 / month $668.06 / month $668.06 / month | |
| Silver HMO |
Prescription drugs (30-day supply)
Additional benefitsPlan resources
Summary of Benefits Coverage |
$2,500 | $6,600 | 30% | $20 | $101.00 / month $159.06 / month $159.70 / month $162.88 / month $166.69 / month $172.90 / month $177.99 / month $180.53 / month $184.35 / month $188.17 / month $190.55 / month $193.10 / month $194.37 / month $195.64 / month $196.92 / month $198.19 / month $200.73 / month $203.28 / month $207.10 / month $210.75 / month $215.84 / month $222.21 / month $229.68 / month $238.59 / month $248.61 / month $260.06 / month $271.36 / month $284.08 / month $296.65 / month $310.48 / month $324.48 / month $339.59 / month $354.70 / month $371.09 / month $387.63 / month $405.28 / month $414.03 / month $431.69 / month $446.96 / month $456.98 / month $469.54 / month $477.18 / month | |
| Silver PPO 2500 |
Prescription drugs (30-day supply)
Additional benefitsPlan resources
Summary of Benefits Coverage |
$2,500 | $6,600 | 20% | $30 | $104.88 / month $165.16 / month $165.82 / month $169.12 / month $173.09 / month $179.53 / month $184.81 / month $187.45 / month $191.42 / month $195.38 / month $197.86 / month $200.50 / month $201.82 / month $203.14 / month $204.47 / month $205.79 / month $208.43 / month $211.07 / month $215.04 / month $218.83 / month $224.12 / month $230.73 / month $238.49 / month $247.74 / month $258.14 / month $270.03 / month $281.76 / month $294.97 / month $308.02 / month $322.39 / month $336.92 / month $352.61 / month $368.30 / month $385.31 / month $402.49 / month $420.82 / month $429.91 / month $448.24 / month $464.09 / month $474.50 / month $487.54 / month $495.47 / month | |
| Silver PPO 1200 |
Prescription drugs (30-day supply)
Additional benefitsPlan resources
Summary of Benefits Coverage |
$1,200 | $6,600 | 40% | $40 | $109.88 / month $173.04 / month $173.74 / month $177.20 / month $181.35 / month $188.10 / month $193.64 / month $196.40 / month $200.56 / month $204.71 / month $207.31 / month $210.07 / month $211.46 / month $212.84 / month $214.23 / month $215.61 / month $218.38 / month $221.15 / month $225.30 / month $229.28 / month $234.82 / month $241.74 / month $249.87 / month $259.57 / month $270.47 / month $282.93 / month $295.21 / month $309.06 / month $322.73 / month $337.78 / month $353.01 / month $369.45 / month $385.89 / month $403.71 / month $421.71 / month $440.91 / month $450.43 / month $469.64 / month $486.25 / month $497.15 / month $510.82 / month $519.13 / month $519.13 / month | |
| Bronze HMO |
Prescription drugs (30-day supply)
Additional benefits
Fitness membership Plan resources
Summary of Benefits Coverage |
$5,000 | $6,600 | 10% | $30 | $87.13 / month $137.22 / month $137.77 / month $140.51 / month $143.80 / month $149.16 / month $153.55 / month $155.74 / month $159.04 / month $162.33 / month $164.39 / month $166.58 / month $167.68 / month $168.78 / month $169.88 / month $170.97 / month $173.17 / month $175.36 / month $178.66 / month $181.81 / month $186.20 / month $191.69 / month $198.14 / month $205.83 / month $214.47 / month $224.35 / month $234.09 / month $245.07 / month $255.91 / month $267.85 / month $279.92 / month $292.96 / month $306.00 / month $320.13 / month $334.40 / month $349.63 / month $357.18 / month $372.41 / month $385.58 / month $394.23 / month $405.07 / month $411.65 / month | |
| Bronze PPO 6600 |
Prescription drugs (30-day supply)
Additional benefits
Fitness membership Plan resources
Summary of Benefits Coverage |
$6,600 | $6,600 | 0% | $0 | $82.67 / month $130.19 / month $130.71 / month $133.32 / month $136.44 / month $141.52 / month $145.69 / month $147.77 / month $150.89 / month $154.02 / month $155.97 / month $158.05 / month $159.10 / month $160.14 / month $161.18 / month $162.22 / month $164.30 / month $166.39 / month $169.51 / month $172.51 / month $176.67 / month $181.88 / month $188.00 / month $195.29 / month $203.49 / month $212.86 / month $222.11 / month $232.52 / month $242.81 / month $254.14 / month $265.59 / month $277.96 / month $290.33 / month $303.74 / month $317.28 / month $331.73 / month $338.89 / month $353.34 / month $365.84 / month $374.04 / month $384.33 / month $390.58 / month | |
| Catastrophic Plan |
This is single coverage for individuals under 30 years of age OR have a hardship exemption from the Hawaii Health Connector. Prescription drugs (30-day supply)
Additional benefitsPlan resources
Summary of Benefits Coverage |
$6,600 | $6,600 | 0% | $50 2 | $77.03 / month $121.31 / month $121.79 / month $124.22 / month $127.13 / month $131.86 / month $135.74 / month $137.68 / month $140.59 / month $143.51 / month $145.32 / month $147.27 / month $148.24 / month $149.21 / month $150.18 / month $151.15 / month $153.09 / month $155.03 / month $157.94 / month $160.73 / month $164.61 / month $169.46 / month $175.17 / month $181.96 / month $189.60 / month $198.34 / month $206.95 / month $216.65 / month $226.24 / month $236.79 / month $247.46 / month $258.99 / month $270.51 / month $283.01 / month $295.62 / month $309.09 / month $315.76 / month $329.23 / month $340.87 / month $348.51 / month $358.10 / month $363.92 / month |
Health benefits
These benefits are included in all HMSA individual plans and others are available when you enroll:
- HMSA’s Online Care.
- An annual physical/wellness exam with no copayment.
- Generic drug coverage*.
- Adult vision coverage.
*Generic drugs are covered before you meet the deductible, except for single-source generic drugs (drugs manufactured by a single pharmaceutical company) dispensed at a pharmacy.