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• 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.

• Services Involving New Technology

  HMSA requires precertification for any treatment involving new technology. The service won't be covered if your treatment doesn't meet HMSA's 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.

• Find an HMSA Participating Retail Pharmacy

  You can use the Find a Doctor tool to find an HMSA participating pharmacy, too. Find out how it works.

• 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.

• Physical and Occupational Therapy FAQs

  HMSA covers short-term physical and occupational therapy that's been diagnosed and ordered by a physician, physician's assistant, or advanced practice registered nurse.

• Physical and Occupational Therapy Benefits

  Physical therapy treats disease or injury using therapeutic exercises and other interventions to restore range of motion, improve posture and strength, and more.

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