Member Resources: HMSA Akamai Advantage Dual Care (PPO D-SNP) 2025
Get the most out of your health plan. Learn about the many benefits you have as an HMSA Medicare Advantage member.
Questions? For help with claims information or health plan benefits, call 808-948-6000 or 1-800-660-4672 seven days a week, 7:45 a.m. to 8 p.m. TTY users, call 711.
If your HMSA Medicare Advantage plan doesn’t meet your needs or if you’d like to file a grievance, call us. You can also call 1-800-MEDICARE (1-800-633-4227) 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 from your plan
Complete a Health Risk Assessment (HRA) every year to stay on track with your health goals. For help, call us at 808-948-6997 or 1-844-223-9856.
Complete your HRA and send it back to us through the mail or by email or fax.
Mail:
Health Coordination Services 6HC
P.O. Box 860
Honolulu, HI 96808
Email: servcoord@hmsa.com
Fax: 808-944-5604
HMSA Screening Checklist
Have a friend or family member act on your behalf if you’re not able to make decisions about your health care.
Changing your plan
Your personal circumstances or health care needs may change as time goes on. Call us at 808-948-6235 or 1-800-693-4672 to learn about other HMSA Medicare Advantage plan options.
Do you need help paying for your prescription drugs? The Low-Income Subsidy program may reduce your prescription drug copayments.
Need to end your health plan? Fill out this form to disenroll from your plan.
If you qualify for this program, a pharmacist will call you to discuss your medications.
Register for and log on to My Account to see your Part D Explanation of Benefits, claims, and to pay your monthly premium online.
Other Supplemental Benefits
Provider Network
Search for health care providers.
Search for pharmacies in Hawaii and on the Mainland.
Search for doctors and eyewear suppliers.
Dental Provider Directory
Find a participating dentist.
Provider Directory
Download the directory to search for doctors, pharmacies, and other health care providers.
Disclaimer: The pharmacy network and provider network may change at any time. You’ll receive notice when necessary.
Silver&Fit Provider Directory
Find a fitness center for your no-cost or discounted membership.
If you’d like an HMSA Akamai Advantage Provider Directory, please fill out this form. We’ll mail it to you within three business days.
These online tools can help you get the most from your prescription drug benefit.
Formulary
Search for medications or download your plan’s drug list. Find cost, availability, and any requirements.
A comprehensive formulary is the list of drugs that your Part D plan pays for.
The formulary may change at any time. We’ll let you know about any changes.
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 Caremark’s Customer Care at 1-855-479-3659 or visit My Account. Learn more about Mail-order Prescription Drug Service.
Drug tools
Manage your prescription drugs using the Caremark mobile app or through My Account on hmsa.com:
- Check drug costs and benefits.
- Search for generic or lower-cost alternatives.
- Keep track of your drug spending.
- Set up mail-order prescriptions.
- Stay on track with automatic refills and set up alerts.
We want to make sure you’re taking medications that are right for you. Your plan must approve certain prescription drugs before you take them.
In some cases, we may ask you to try a less-expensive drug before we pay for a more-expensive one.
Evidence of Coverage
The Evidence of Coverage contains details about your health plan. 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 Medicare Advantage member. Since this document changes every year, please read and keep the latest updated version for your reference even if you don’t change plans.
If your HMSA Medicare Advantage plan doesn’t meet your needs or if you’d like to file a grievance, call us. You can also call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, seven days a week. For TTY, call 1-877-486-2048. You can also submit a complaint at medicare.gov.
Annual Notice of Changes
This document tells about the changes to your plan. To get more information about costs, benefits, or rules, please review the Evidence of Coverage.
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 and we can help you.
EOC Chapter 9, Sec. 6.2
Call us to see if your plan pays for certain medical services and how much they may cost.
EOC Chapter 9, Sec. 6.3
If you disagree with our decision to deny a medical 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 your health plan benefits or payment.
EOC Chapter 10
Find out what you need to do if your health plan ends.
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 we denied your request to pay for a prescription drug, 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 and your doctor to find a solution. We’ll do our best to help 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
If your HMSA Medicare Advantage plan doesn’t meet your needs or if you’d like to file a grievance, call us. You can also call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, seven days a week. For TTY, call 1-877-486-2048. You can also submit a complaint at medicare.gov.
For your safety, prior authorization, or precertification, is required for certain medical services. That means your provider will need to ask HMSA if we’ll pay for that service. If you’d like to receive a service but aren’t sure if your plan will pay for it, call us or check your Evidence of Coverage.
If you disagree with a claim we denied, you can appeal that decision.
You can authorize someone to act as your representative for certain health care decisions.
Coverage Determinations and Appeals for Prescription Drugs
If your HMSA Medicare Advantage plan doesn’t meet your needs or if you’d like to file a grievance, call us. You can also call 1-800-MEDICARE (1-800-633-4227) 24 hours a day, seven days a week. For TTY, call 1-877-486-2048. You can also submit a complaint at medicare.gov.
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.
If your request for a prescription drug is denied, you can appeal that decision.
You can authorize someone to act as your representative for certain health care decisions.
