What is HMSA’s Care Access Assistance Program?
HMSA’s Care Access Assistance Program, or CAAP, offers airfare reimbursement assistance to HMSA members to fly to another island for specialty care when that care isn’t available on their home island. The program improves access to care for members who live in rural areas.
Who qualifies for CAAP?
Most HMSA members qualify for the program. HMSA QUEST and certain HMO members have interisland transportation benefits in their plans and don’t need CAAP. Ask your doctor or health care provider for more information.
How does the program work?
- Your provider:
- Determines that appropriate specialty care isn’t available on your home island or isn’t available from an HMSA participating provider on your island.
- Refers you to an HMSA participating specialist or facility on another island.
- Completes a Travel Request Form on the Hawaii Healthcare Information Network at hhin.hmsa.com before your appointment or not more than five business days after your appointment. Your provider must submit a travel request for each specialist or facility for which you have a scheduled appointment.
- HMSA’s travel department:
- Reviews the request and pertinent information as soon as possible depending on your appointment. The travel coordinator will approve reimbursement for one appointment at a time.
- Will notify you in writing if your request does or doesn’t meet program guidelines.
- If the request meets program guidelines, please:
- Make your own travel arrangements.
- Submit your receipts to the HMSA travel department with a copy of the specialist-signed provider certification letter certifying that you kept your appointment:
- Online: Use the Travel Reimbursement Plan Form in your HMSA My Account to submit your receipts and the provider certification letter. Log in to My Account, open the Forms menu, and select Travel Receipts.
- Fax: 808-944-5600
- Mail: HMSA Travel Department, P.O. Box 860 Honolulu, HI 96808
- Make sure your receipts have your name, the date of travel, the amount you paid for airfare, and proof of payment. Credit card statements are not acceptable. We’ll reimburse you up to a set amount for each one-way travel segment.
- If you need a follow-up appointment with the same provider, you must call HMSA before the appointment at 808-948-5440 or 1-844-357-0726 or email TravelCoordination@hmsa.com. Airfare receipts are not considered a follow-up request.
Can I see any provider on another island?
No. Airfare expenses may be allowed only if you need to see an HMSA participating specialist on another island. For purposes of this program, family practitioners, general practitioners, internists, optometrists, podiatrists, advanced practice registered nurses, and physician assistants aren’t considered specialists. Exceptions may be made for visits to providers with specific subspecialties (e.g., a pediatric cardiologist). Also, airfare costs won’t be reimbursed for visits to dental, vision, or rehabilitation (such as physical and occupational therapy) providers.
Are there any restrictions or limitations?
Yes. Interisland airfare can’t be reimbursed if you’re:
- Referred to a specialist who doesn’t participate with HMSA.
- Referred for a service that isn’t a benefit or is a specific exclusion of your HMSA plan (e.g., cosmetic surgery).
- Unwilling to see a specialist on your home island.
- Unwilling to take an available appointment with a specialist on your home island.
You also can’t be reimbursed for:
- First-class or multiple seats.
- Companion airfare (for members 18 years of age and older).
- More than one companion airfare per household (for members 17 years of age and under).
- Trips that use airlines miles, gift cards, and/or vouchers.
- Lodging.
- Ground transportation.
- Parking.
- Meals.
- Airline fees and costs to change reservations.
- Intra-island transportation (e.g., traveling from Hilo to Kona).
- Transportation within your home island, such as traveling from Hilo to Kona.
- CAAP referrals received more than five business days after the specialty service is rendered.
- Requests received more than five business days after the specialty service is rendered.
- More than six round trips for services requiring a daily course of treatment (e.g., radiation therapy, chemotherapy).
- More than 10 round-trip tickets per calendar year.
What about follow-up appointments?
If HMSA approves reimbursement to fly to a specialist for the initial visit, please notify us before each follow-up visit in writing, by email, or phone. Reimbursement is approved for one visit at a time.
Can I request airfare reimbursement retroactively?
Yes, but we must receive the request within five business days of the service being rendered, and the service must meet the requirements.
What about urgent appointments?
If urgent care is needed, the referring provider should contact HMSA’s Care Access Assistance Program at 808-948-5440 or 1-844-357-0726 or submit a travel request on HHIN immediately. You can make an appointment and your own travel arrangements. Our decision to reimburse the airfare costs will be made retroactively, but only if we receive the request within five business days of the service being rendered.
Booking Your Flight
You can make your appointments and travel arrangements to fit your schedule and medical needs.
- After you have made your travel arrangements, completed your travel, and kept your appointment: You must provide us with original receipts showing the name of the traveler, airfare cost, amount paid, proof of payment, dates of travel, and airline with a copy of the specialist-signed provider certification letter certifying that you kept your appointment.
- Submit your documents through My Account: Through your HMSA My Account, you can use the online Travel Reimbursement Plan Form to submit your receipts and the provider certification letter to HMSA. Log in to My Account, open the Forms menu, and select Travel Receipts. You can also mail or fax these documents to HMSA’s travel department following the instructions in the travel confirmation letter. We’ll process the reimbursement as soon as we can if we receive all the information we need.
Getting the Care You Need
HMSA wants you to get the appropriate care. HMSA’s CAAP can help you see the provider you need to no matter what island you’re on. If you have questions about the program, talk to your provider or call HMSA at 808-948-5440 or 1-844-357-0726.