Hawaii Medical Plan

If you live in Hawaii, your medical plans are offered through HMSA. You can choose from a Health Maintenance Organization (HMO) plan that covers only in-network care or a Preferred Provider Organization (PPO) plan that covers both in- and out-of-network care.

Since the big difference between the two plans is in-network vs out-of-network coverage, you’ll want to check if the doctors who are important to you are in-network. You can call (800) 776-4672 or view the Online Provider Directory at hmsa.com.

Below are more details on the plans:

HMSA Health Maintenance Organization (HMO) plan

This plan covers in-network care including office visits, prescription drugs, naturopathy, acupuncture and hearing aids. There is no deductible and you pay nothing for preventive care. You’ll pay less out of your paycheck for this plan and you have a $20 copay for primary care and specialists (you need a referral).

The maximum you’ll pay for the year is $2,500 for an individual or $7,500 if you cover dependents. The maximum you’ll pay for the year for prescription drugs is $3,600 for yourself and $4,200 if you cover dependents.

HMSA Preferred Provider Organization (PPO) plan

This plan covers both in-network and out-of-network care including office visits, prescription drugs, acupuncture and hearing aids. You pay more out of your paycheck for this plan than the HMO plan as you’re able to see any doctor you’d like.

There is no deductible for in-network care and you pay nothing for preventive care. For out-of-network care, there is an annual deductible of $100 for yourself or up to $300 if you cover dependents. This plan charges a $12 copay or coinsurance for office visits. No referrals are needed for specialists.

The maximum you’ll pay for the year is $2,500 if it’s only you or $7,500 if you cover dependents for medical services. The maximum you’ll pay for the year for prescription drugs is $3,600 individually and $4,200 if you cover dependents.

COSTS

HMSA Bi-Weekly Costs for Medical Plans (No Domestic Partner Enrolled)

Plan Year: Jan 1, 2019 – Dec 31, 2019

Coverage Election Medical
  HMO PPO
  Employee Employer Employee Employer
Employee Only $6.00 $198.47 $6.00 $202.82
Employee plus Spouse $74.00 $393.80 $99.00 $378.76
Employee plus Children $54.00 $333.89 $84.00 $312.15
Employee plus Family $96.00 $555.82 $136.00 $529.70
Additional Working Partner Premium1 $46.15 $46.15

Domestic Partner Enrolled2: HMSA Bi-Weekly Pre-Tax vs Post-Tax Contributions for Medical Plans

Plan Year: Jan 1, 2019 – Dec 31, 2019

Coverage Election Medical
  HMSA HMO HMSA PPO
  Pre-Tax Post-Tax Pre-Tax Post-Tax
Employee plus DP $6.00 $68.00 $6.00 $93.00
Employee plus Children
(where only DP children are covered)
$6.00 $48.00 $6.00 $78.00
Employee Plus Family
(where DP and at least one non-DP child are covered)
$28.00 $68.00 $43.00 $93.00
Employee Plus Family
(where DP and only DP child(ren) are covered)
$0.00 $96.00 $0.00 $136.00
Employee Plus Family
(where no DP and only DP child(ren) are covered)
$48.00 $48.00 $58.00 $78.00

Domestic Partner Enrolled3: HMSA Bi-Weekly Imputed Income

Plan Year: Jan 1, 2019 – Dec 31, 2019

Coverage Election Medical
  HMO PPO
Employee plus DP $195.33 $175.94
Employee plus Children
(where only DP children are covered)
$135.42 $109.33
Employee Plus Family
(where DP and at least one non-DP child are covered)
$195.33 $175.94
Employee Plus Family
(where DP and only DP child(ren) are covered)
$351.35 $320.88
Employee Plus Family
(where no DP and only DP child(ren) are covered)
$135.42 $109.33

1You’ll pay an additional working partner premium of $46.15 per pay period if you’re covering a spouse or domestic partner who chooses not to be covered through their employer as primary coverage.

2You are responsible for paying both the pre-tax and the post-tax portion of the contribution.

3This represents the amount that T-Mobile pays for your domestic partner’s coverage. Because the IRS doesn’t consider them to be a tax dependent, this amount is added to your paycheck as taxable income.

Provider Contact
HMSA: hmsa.com (800) 776-4672