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• When You Don't Recognize a Provider on Your Report to Member

  Don't worry if you see a name you don't recognize on your report to member. The provider may have asked for laboratory, diagnostic, anesthesia, or other service with no direct contact with you.

• 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 a Report to Member?

  The Report to Member is an explanation of benefits. It is not a bill for services or supplies.

• What if I Need Medical Care on the Mainland?

  Depending on your medical plan, you can receive services such as emergency and urgent care, or see a physician for a covered benefit while traveling on the Mainland.

• Using Nonparticipating Providers for Physical or Occupational Therapy

  If you're currently seeing a provider outside Hawaii or a nonparticipating provider for therapy services, ask the provider to submit a precertification request for any services.

• Determining PPO Cost for Care Outside of Hawaii

  Find out how much PPO services may cost when you travel to the U.S. Mainland.

• Submitting a Precertification Request

  Learn the steps you need to take to submit a precertification request by yourself or through a provider.

• Services that are Reconstructive, Corrective, or Cosmetic

  Reconstructive or corrective services are a benefit of your plan when they're required to restore, reconstruct, or correct a bodily function that was lost, impaired, or damaged due to an illness or injury.

• Prior Approval For Medical Services (Precertification)

  For some services, you or your physician must get approval from HMSA to make sure the services meet our payment guidelines.

• 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.

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