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• 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'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.

• 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.

• Services Your Plan Doesn't Cover

  Our benefits are designed to keep you safe, promote correct use of services, and keep health care costs down.

• 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.

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