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• Who Qualifies as an Eligible Dependent?

  Generally, a subscriber's spouse and children are eligible dependents. Check with your plan administrator or Guide to Benefits for more information.

• When to Enroll Dependents in Your Health Plan

  There are several things you may have to consider if you want to add an eligible dependent to you plan.

• When Prior Approval (Precertification) is Denied or Not Requested

  If your precertification request is denied and you disagree with HMSA's decision, you or your provider may submit an appeal.

• 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.

• 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.

• 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.

• Screening and Diagnostic Tests

  HMSA plans cover a variety of tests that can fall under one of two categories: screening or diagnostic. The reason you are taking a test determines the category.

• Request For Insurance Commissioner External Review

  You can ask to have an independent review organization look over your appeal if you think we made a mistake.

• Physical Exams

  Your physical exam benefits will cover a checkup and any vision, hearing, or other recommended screening tests appropriate for your age and gender.

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