QUEST Integration-Net, QUEST Integration-ACE, and Basic Health Hawaii – Member Information

Original Effective Date:

04/01/1996; 01/01/2015 (BHH)

Current Effective Date:

01/01/2015

Eligibility

The QUEST Integration-Net plan consists of members who do not qualify for QUEST Integration.

QUEST Integration-ACE consists of members who would be eligible for QUEST Integration but were unable to enroll due to the enrollment cap, and are unable to enroll in QUEST Integration-Net because they were not already QUEST Integration or Medicaid fee-for-service recipients.

The Basic Health Hawaii program is a state-funded program administered through existing QUEST Integration contracts for uninsured non-pregnant adults, 19 years and older, who are non-immigrants or are qualified aliens residing in the US for less than five years and must reside in Hawaii.

Other Insurance

If a QUEST Integration-Net, QUEST Integration-ACE, or Basic Health Hawaii member has other coverage, the benefits of the other insurance are primary to QUEST Integration-Net, QUEST Integration-ACE, or Basic Health Hawaii and must be applied before QUEST Integration-Net, QUEST Integration-ACE, or Basic Health Hawaii benefits are used.

Pregnant Women

Maternity care is not a benefit for any of these plans. Pregnant members may be enrolled in QUEST Integration to receive full QUEST Integration benefits for maternity care until the end of their post-partum period, which begins the month of birth and includes two calendar months following the birth. Her eligibility is then re-determined by the state for continued enrollment in QUEST Integration or movement back to QUEST Integration-Net, QUEST Integration-ACE, or Basic Health Hawaii. Newborns are added to the mother’s QUEST Integration plan.

To ensure that pregnant members receive coverage of prenatal care, please notify QUEST Integration Provider Service of a member’s pregnancy so that QUEST Integration eligibility can be determined.

Membership Cards

New QUEST Integration-Net, QUEST Integration-ACE, or Basic Health Hawaii enrollees receive a notification letter from the state identifying them as eligible members of the applicable plan. This letter is acceptable documentation of coverage until the member receives his or her membership card. The letter must identify HMSA as the QUEST Integration-Net, QUEST Integration-ACE, or Basic Health Hawaii plan and is valid only 30 days from the date of the letter. If the letter is used to document eligibility, attach a copy of the letter to any claim submitted.

Cards are sent to members at the time of their enrollment in HMSA’s plans and when there are changes in eligibility status.

Language Translation Services

HMSA’s multicultural staff can communicate with members in various languages, including Samoan, Tagalog, Ilocano, Japanese, Korean, Chinese and Vietnamese. We also can arrange for translation services through community based agencies for other languages to help members communicate with their doctors or other providers. This must be arranged in advance. If you have a scheduled patient who finds it difficult to communicate in English and who does not have someone who can accompany him or her to help with translation, please call QUEST Integration Provider Service to arrange for a translator to be available for the visit.

Revision History