Member Resources: HMSA Akamai Advantage Dual Care 2016

Request HMSA Akamai Advantage Provider Directory

If you’d like an HMSA Akamai Advantage Provider Directory, please fill out the form below. We will mail it to you within three business days.

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We’ll mail your HMSA Akamai Advantage Provider Directory within three business days. If you have other questions you would like to get answered now, please call us.


Hours Available
You can call from 8 a.m to 8 p.m., seven days a week

To get the most out of your health plan, learn about the many benefits you have as an HMSA Akamai Advantage member.

Questions? For help with claims information or health plan benefits, call 808-948-6000 on Oahu or 1-800-660-4672 toll-free seven days a week, 8 a.m. to 8 p.m. TTY users, call 711.

If your HMSA Akamai Advantage plan doesn’t meet your needs or to file a grievance, call us. You can also call 1-800-MEDICARE 24 hours a day, seven days a week. For TTY, call 1-877-486-2048. You can also submit a complaint at medicare.gov.


Tools to help you get the most out of your plan

Appoint an authorized representative

Have a friend or family member act on your behalf if you’re too ill to make decisions about your health care.

Instructions Download

Interpretive Services

Talk to someone who speaks your language.

Download

My Account

Register for and log on to My Account to see your Part D Explanation of Benefits online.

Changing your plan

Your health care needs may change as time goes on. Call us to learn about other HMSA Akamai Advantage plan options.

Instructions Download

Disenrollment Request

Need to end your health plan? Fill out this form to disenroll from your plan.

Instructions Download

Medication Therapy Management Program

If you qualify for this program, a pharmacist will call you to discuss your medications.

Personal Medication List

Extra Help

Do you need help paying for your prescription drugs? The Low-Income Subsidy Program may reduce your copayments.


Provider Network

Find a Doctor

Search for health care providers.

Provider Directory

Search for doctors, pharmacies, and other health care providers.

Disclaimer: The pharmacy network and provider network may change at any time. You will receive notice when necessary.

Find a pharmacy

Search for pharmacies in Hawaii.

Request a provider directory

If you’d like an HMSA Akamai Advantage Provider Directory, please fill out the form. We’ll mail it to you within three business days.


Prescription Drugs

Use these online tools to find out if your prescriptions are a benefit of your plan.

Formulary

Search for medications or download the latest version of our list of drugs in your plan. Find cost, availability, and any requirements.

Comprehensive formulary

A comprehensive formulary is the entire list of drugs that your Part D plan pays for.

The formulary may change at any time. You will receive notice when necessary.

Mail–order Prescription Drug Service

Save time and money when you get an extended supply of maintenance medications for chronic conditions mailed to your home. To sign up, call CVS Customer Care at 1-800-479-3659 or visit My Account.

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Prior authorization

To make sure you’re getting the medications that are right for you, certain prescription drugs require approval from your plan first.

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Step therapy

In some cases, we may ask you to try a less-expensive drug before we pay for a more expensive drug.

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Evidence of Coverage

The Evidence of Coverage contains detailed plan information. It includes important information such as phone numbers, a list of medical services your plan pays for, and your rights and responsibilities as an HMSA Akamai Advantage member. We recommend that you read this important document and keep it for reference.

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Membership card

EOC Chapter 1, Sec. 3.1

Your HMSA membership card is your ticket to quality medical care in Hawaii. Carry it with you when you see a doctor or go to a hospital.

Important numbers and resources

EOC Chapter 2

Need to speak with someone about a claim? Call us to learn more about your health plan.

Coverage decisions

EOC Chapter 9, Sec. 5.2

Call us to find out if your plan pays for a certain medical service and how much it may cost.

Exceptions and appeals

EOC Chapter 9, Sec. 6.3

If you disagree with our decision to deny a claim, we’ll take a second look at it.

Grievances

EOC Chapter 9, Sec. 11

If your plan isn’t meeting your needs, you can file a complaint about the quality of care you receive, waiting times, customer service, or other concerns not related to benefits, coverage, or payment.

Ending your membership (disenrollment)

EOC Chapter 10

Find out what you need to do if you or HMSA ends your health plan.

Coverage determination

EOC Chapter 9 Sec. 7.4

You can ask us about your prescription drug benefits, including quantity limits, prior authorization, step therapy, and cost sharing.

Appeals for prescription drugs

EOC Chapter 9 Sec. 7.5

If you asked us to pay for a certain prescription drug and we denied your request, you can appeal our decision.

Exceptions for prescription drugs

EOC Chapter 9 Sec. 7.2

If your health plan doesn’t pay for a drug you need, we’ll work with you to find a solution. We want to make sure you get the medications you need.

Transition process

EOC Chapter 5 Sec. 5.2

If your health plan doesn’t pay for a drug that you need, we may offer you a temporary supply. This gives you and your doctor time to find an alternative treatment.


Organization Determinations and Appeals for Medical Benefits

Organization determinations
(Prior authorization)

For your safety, prior authorization, or precertification, is required for certain medical services. That means your provider will need to ask your health plan first whether it will pay for that medical service. If you’d like to receive a medical service but aren’t sure if your plan will pay for it, call us or check your Evidence of Coverage.

Appeals

If you disagree with us on a claim we denied, we’ll take a second look at it.

Appointing a representative

You can authorize someone to act as your representative for certain health care decisions.

Instructions Download


Coverage Determinations and Appeals for Prescription Drugs

Coverage determinations

Need a drug that your health plan doesn’t pay for? Need an exception to prior authorizations, quantity limits, step therapy or drug tiers? You or the doctor who prescribed the medication can ask us to make an exception.

Instructions Download

Appeals

If your request for a prescription drug is denied, you can appeal that decision.

Instructions Download

Appointing a representative

You can authorize someone to act as your representative for certain health care decisions.

Instructions Download