HMSA has launched an online tool to help private business plan members find their estimated out-of-pocket costs for certain medical services or items. As mandated by the CMS Transparency in Coverage Rule and the Consolidated Appropriations Act, health plans must provide private business plan members with the ability to compare out-of-pocket costs for specific items or services.

Currently, the online tool can generate cost estimates for a limited number of medical items and services. We’re working to add more features and include all covered services.

The estimated costs are derived from HMSA claims data, provider information, and HMSA health plan benefits. Please note that the specific services you receive from your provider may be different from those in the cost tool and that this difference could affect your out-of-pocket cost.

The online tool will calculate the out-of-pocket cost for only one plan at a time. Out-of-pocket costs won’t reflect coordinated benefits for members who have more than one HMSA private business plan.

Please contact us if you have any questions about the online tool.