Who we accept payment from
HMSA will accept premium payments directly from the member. In addition, HMSA will accept third- party payment of premiums and cost sharing payments on behalf of a member from the following:
- The member’s family;
- The member’s current employer;
- Local, state or federal government programs, including grantees directed by a government program to make payments on its behalf;
- Ryan White HIV/AIDS programs;
- Indian tribes or tribal organizations/governments; and
Religious institutions and other not-for-profit organizations when each of the following criteria is met:
- a. The assistance is provided on the basis of the insured’s financial need;
- b. The institution or organization is not a healthcare provider; and
- c. The institution or organization is financially disinterested (i.e., the institution/organization does not receive funding from entities with a pecuniary interest in the payment of health insurance claims and/or benefits).
In accordance with applicable law and regulatory guidance, HMSA generally does not accept premium payments from third parties that are not described in numbers 1-6 above,1 with one exception.
Effective February 1, 2018, HMSA will accept third party payments of premiums for COBRA group health plan continuation coverage on behalf of any member who has such continuation coverage. Upon termination of member’s COBRA continuation coverage, and subsequent re-enrollment in other (non-COBRA) HMSA coverage, the general prohibition on third-party payments by persons or entities not described in numbers 1-6, above, will apply.
What happens when others try to pay
HMSA may, in its sole discretion and in accordance with applicable law and regulatory guidance, decline to accept premium and cost sharing payments made directly or indirectly2 by any other person or entity from which HMSA is not required by law to accept third-party premium and/or cost sharing payments. “Payments” include those made by any means, for example: cash, check, money order, credit card payment, debit card payment, electronic funds transfer, etc. Third parties not listed above are referred to as “ineligible third parties.” For purposes of clarity, but not limitation, commercial (or for-profit) entities, hospitals, and other health care providers (including, without limitation, suppliers) may be ineligible third parties.
Any cost-sharing paid by ineligible third parties will not be counted toward a subscriber and/or member’s deductible or out-of-pocket maximum. “Cost-sharing” includes payments such as deductibles, copayments and coinsurance. HMSA may make retroactive adjustments to account for any payments made by ineligible third parties.
Let us know if you have any changes
You are required to immediately notify HMSA of any change in your (or your dependent(s)) information submitted in connection with the application for coverage or otherwise provided with respect to any third-party payment.
Why is this important
Payments of premiums and/or cost-sharing by ineligible third parties have the potential to create conflicts of interest, skew the health coverage risk pool and increase the risk of adverse selection. This is detrimental to the long-term viability of the health coverage market overall and can result in increased rates for the entire market.
HMSA maintains sole discretion with respect to its acceptance of third-party payments. HMSA may make changes to its administration of the same at any time and as otherwise needed to support compliance with law and/or applicable regulatory guidance.
If you have questions about this third-party payment policy or whether HMSA will accept premium and/or cost-sharing payments made by a specific person or entity, we can help. Please contact us at 808-948-6371 on Oahu or 1-866-610-1050 toll-free on the Neighbor Islands, Monday – Friday, 8 a.m. – 5 p.m.
1 HMSA will cease accepting premium payments made by ineligible third parties made directly and indirectly to
HMSA. Indirect payments are payments made to HMSA by the member using funds provided to them by an
ineligible third party not included in numbers 1-6 above.
2 Direct payments are payments made directly to HMSA by an ineligible third party on behalf of the member. Indirect payments are payments made to HMSA by the member using funds provided to them by an ineligible third party.