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• When to Use the Emergency Room

  Emergency services are for sudden and serious injuries or illnesses. If you have a condition that requires emergency care, call 911 or go to the nearest emergency room.

• What's an Eligible Charge?

  The eligible charge is the lower of the participating provider's actual charge or HMSA's maximum allowable fee.

• What's an Annual Deductible?

  The annual deductible is a fixed dollar amount you pay for covered services each calendar year or plan year before HMSA will pay for certain services.

• What's an Annual Copayment Maximum?

  The annual copayment maximum is a fixed limit or cap to your total out-of-pocket expenses for most covered services in a calendar year or plan year.

• What's a Lifetime Maximum?

  A lifetime maximum is the maximum dollar amount that will be paid on your behalf under your HMSA plan.

• What’s a Benefit Maximum?

  A benefit maximum is a limit on a covered service or supply. A service or supply may be limited by dollar amount, duration, or number of visits.

• Single-Source Generic Drugs

  When a patent expires for a brand drug, the FDA can grant a period of exclusivity to one company to make the generic form of the drug.

• Seeing Specialists and Other Providers When You’re an HMO Member

  As an HMO member, your primary care provider coordinates your medical care and will refer you to specialists when needed.

• Marriage: Adding a Spouse to Your Plan

  You can add your spouse to your HMSA plan within 31 days of your wedding day. The effective date of coverage will be the first day of the next month.

• Important Life Events that can Affect Your Membership

  Links to important information on having a child, getting married, getting divorced, or the passing of a loved one.

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