What you get with your plan

If you have health insurance, you already know that you won’t have to spend a fortune when you see a doctor. But your health insurance often has more benefits than you realize. And since you’re paying for it, you might as well know what you’re getting.

Medical benefits

Basic medical insurance typically pays for emergency services, routine care like physicals and exams, doctor visits, and lab tests.

The amount that your plan pays for depends on the fine print in your plan. Few plans cover 100 percent of the cost of any medical service, and copayments and deductibles can add up. Some plans limit the number of visits or tests they’ll pay for each year. Others may require that you pay all your costs on your own until you reach a limit when the plan kicks in.

On the other hand, health insurance protects you by capping the annual amount you pay out of pocket. So if you get really sick or injured, you can have peace of mind knowing that you’ll never have to pay more than that amount in a given year.

Also, most health plans only pay for services that they consider medically necessary. That means that you’ll have to foot the entire bill for any Botox or aromatherapy sessions.

Don’t forget your HMSA membership card.
Carry your health insurance membership card wherever you go. It can help you find a doctor and pay for medical costs while you’re away on another island, on the Mainland, or across the world.

Prescription drug benefits

Make sure your health insurance pays for prescription drugs. Check with your health insurer about your plan’s drug benefits and how much they cost. This is especially important if you take a lot of medicine for chronic conditions like high blood pressure, high cholesterol, or asthma.


Find out if the prescription medicine you take is on the health plan’s formulary. A formulary is a list of drugs that your health plan pays for. You may still have to pay a portion of the drug cost through a copayment. Insurance companies determine their formulary based on drug prices, effectiveness, and safety. The formulary may categorize the drugs into the following tiers, ranked from the cheapest to the most expensive.

Tier 1

These drugs work the same as brand-name drugs, but are cheaper because they don’t have high advertising or marketing costs.

Tier 2
Preferred brand

These are brand-name drugs that don’t have a generic version.

Tier 3
Brand name

These are expensive because they have high research, development, and marketing costs.

Tier 4
Specialty brand

These are the most expensive because they treat complex medical conditions.

Save money with generics
Ask your doctor or pharmacist if there are generic drugs for your prescription. They’re the most affordable and are as safe and effective as brand-name drugs. It’s like buying $200 designer jeans versus $50 jeans. They have a similar look, fit, and function despite the different price tag.

You should also find out if the health plan offers a mail-order prescription drug program so you can get a three-month supply of maintenance medications mailed to your home. Maintenance medications are medicines for ongoing medical problems like high blood pressure, high cholesterol, arthritis, or diabetes. Ordering medications through the mail saves you money.

Preventive care

Thanks to the 2010 Affordable Care Act (ACA), all health insurers are required to pay for preventive screenings like cholesterol tests, colonoscopies, immunizations, prenatal care, and routine care for children at no extra cost to members. Learn more about what exactly the ACA covers.

Getting screened for cancer and other chronic diseases can save your life. That’s because many of these diseases don’t show symptoms until it’s too late.

Health & wellness support

We all know we’re supposed to eat healthy, exercise, and not smoke, but knowing and doing are very different. Sometimes we need a little help - education, support, or a gentle push - to reach those health goals.

Your health insurer probably offers classes and programs to help you. Lots of insurers offer stop-smoking or weight-loss coaching, educational classes and workshops, discounts on health products and services, behavioral health support, and even rewards for meeting your health goals.

Care while traveling

Health care is the last thing you want to worry about when you’re traveling. But accidents or emergencies can happen wherever you are.

Whether you’re on vacation in a foreign country or going to school on the Mainland, find out if your health plan pays for care away from home, including that location.

Consider these questions on your travel checklist:

  • Do I have all my necessary shots and vaccines?
  • Am I bringing enough medicine for my entire trip?
  • Where are the nearest doctors or hospitals in the area I’ll be traveling to?
  • Where is the nearest emergency room?
  • What kind of care do they provide?
  • How is the quality of care?
  • Will doctors or hospitals accept my health insurance?
  • Will I have to submit claims to my health insurer or will that paperwork be done for me?
  • What is the number to call if I have questions or need help?
  • Does my health insurance help pay for prescription drugs? Where is the nearest pharmacy?