- What is a deductible?
A deductible is the initial fee that a member pays for certain services or supplies before insurance payment or reimbursement begins. Please refer to your summary plan description regarding your deductible as the details vary by plan.
- What is the eligible charge?
HMAA’s payment is not based on the billed charge. It is based on the eligible amount or the contracted rate for that particular service. If the provider is not contracted with HMAA, the rate is based on an eligible charge schedule set by HMAA.
- What is the difference between "co-insurance" and "co-payment"?
Co-insurance is the percentage of the covered expense payable by the Plan and by the member. After the calendar year deductible has been met and any required co-payment has been made, the Plan pays the percentage of eligible charges shown in the Schedule of Benefits.
Co-payment is the portion of covered expense payable by the member (in addition to the calendar year deductible) and is listed on the Schedule of Benefits. A co-payment applies each time you receive covered services, when applicable.
- Who is responsible for paying the tax on medical, dental, and vision claims?
According to Hawaii State Law, the General Excise Tax is an expense of doing business and is generally passed on to patients, which means that you are responsible for paying any applicable tax in addition to your co-insurance and co-payment. Please note: Your provider should charge you tax based on the eligible charge of the claim and not the actual billed charge.
- If I am expecting or adopting a baby, what must I do to enroll my child in the Plan?
You must fill out an application to enroll your newborn child within 31 days from his/her date of birth or date of adoption. If you do not add your newborn to your policy in the time frame allotted, you will have to wait until the open enrollment period of the policy.
If you are a member of an employer group, you may download an enrollment application from our website, or you may contact your employer for a form. Please contact HMAA’s Customer Service Center at 941-4622 or toll-free at 1-888-941-4622 to request an application or for more information.
- What is the difference between "participating" and "non-participating" providers?
HMAA Participating Providers have agreed to render medically necessary services at negotiated rates. You are not responsible for the difference between the negotiated rate and the billed charges, except for deductible, co-payments, co-insurance, and non-covered items.
HMAA has no agreement with Non-Participating Providers. Therefore, you will be responsible for all non-covered charges including the difference between the billed charges and HMAA’s non-participating provider eligible charges, any co-pays, co-insurance, and deductibles. Please refer to the par/non par illustration sheet on our website or call Customer Service to have a copy sent to you.
- How can I find out if a healthcare provider is a participating provider with HMAA?
Prior to scheduling your appointment, be sure to ask your doctor if he or she is contracted with HMAA. Or, you may contact HMAA’s Customer Service Center at 941-4622 or toll-free at 1-888-941-4622 or you may view our Provider Directory online.
- What should I do if I need medical services on the Mainland?
HMAA offers you access to medical care through its Mainland networks, Private Healthcare Systems (PHCS) and Multiplan. If you are planning to travel to the Mainland, please contact PHCS or HMAA prior to traveling to identify participating providers in the areas you intend to visit:
Private Healthcare Systems (PHCS) Healthy Directions Network
Call toll-free: 1-888-721-7427
Visit their website at: www.multiplan.com
Or call HMAA’s Customer Service Center for assistance
Call 941-4622 or toll-free 1-888-941-4622
On the PHCS website at Step 2 “Choose A Network,” please select Healthy Directions. If you’re provider is not available in the PHCS Healthy Directions Network, you may then search by selecting the MultiPlan Network.
It is important to remember that HMAA’s geographic service area is the State of Hawaii. Whether it’s one of our many Hawaii providers, or a PHCS/MultiPlan provider, using a participating provider or facility will maximize your coverage and limit your out-of-pocket expense. As an HMAA member, you are able to access the PHCS Healthy Directions Network or Multiplan’s Complementary Network should you require medical services, including emergency care, while traveling to the Mainland. If you have medical coverage through HMAA, present your ID card to a PHCS or Multiplan participating provider and you will receive services at the participating provider level, which will significantly reduce your out-of-pocket expense.
You may use a provider or facility that is non-participating with HMAA, PHCS or Multiplan. However, because HMAA has no agreement with these non-participating providers and facilities, your out-of-pocket expenses will be significantly higher.
The PHCS and Multiplan Mainland networks do not apply to dental or alternative care (chiropractic, naturopathic, and acupuncture) services.
Please review our Out-of-State and Out-of-Country Instructions for more information.