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• ACA Plan Resources

  This transparency in coverage will tell you how to submit claims, get preauthorization, and see if a prescription drug is covered.

• HMSA Medicare Advantage Coverage Determination Request

  Fill out this form if you have Medicare Part D and want to know if HMSA will cover a prescription drug and how much it will cost you.

• Payment Determination Criteria

  HMSA applies payment determination criteria to determine if a service or supply is covered by your plan.

• Organization Determination (Request for Prior Authorization)

  Some services and medical care require a coverage decision by HMSA before they can be covered.

• Essential, Optimal, and Metallic Formulary Coverage Determination Request

  Need a prescription drug that’s not on your formulary? Get instructions on how to start the request process with your doctor.

• How to Appeal an HMSA Decision as a Commercial Member

  An appeal is a formal way of asking HMSA to review a decision on a denied claim. Learn more about the process.

• QUEST Integration Formulary Exception Request

  Need a prescription drug that's not on your formulary? Get instructions on how to start the request process with your doctor.

• Durable Medical Equipment: Renting, Buying, and Buying Online

  Most HMSA plans cover durable medical equipment such as hospital beds, wheelchairs, and insulin pumps.

• Durable Medical Equipment

  HMSA covers renting and purchasing durable medical equipment. Learn how the process works and what you need to do.

• 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.

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