Member Resources: HMSA Akamai Advantage Dual Care 2017
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.
You can call from 8 a.m to 8 p.m., seven days a week
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.
Talk to someone who speaks your language.
Register for and log on to My Account to see your Part D Explanation of Benefits online.
Search for health care providers.
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.
Search for medications or download the latest version of our list of drugs in your plan. Find cost, availability, and any requirements.
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.
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.Download
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.
EOC Chapter 2
Need to speak with someone about a claim? Call us to learn more about your health plan.
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.
EOC Chapter 9, Sec. 6.3
If you disagree with our decision to deny a claim, we’ll take a second look at it.
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.
EOC Chapter 10
Find out what you need to do if you or HMSA ends your health plan.
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.
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.
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.
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
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.
If you disagree with us on a claim we denied, we’ll take a second look at it.
Coverage Determinations and Appeals for Prescription Drugs
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.