You may also contact our Customer Service Center for assistance.
A deductible is the amount you owe for health care services your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1000, your plan won’t pay anything until you’ve met your $1000 deductible for covered health care services subject to the deductible. The deductible may not apply to all services.
This is the maximum amount on which payment is based for covered health care services. This may also be called “allowed amount,” “eligible expense,” “payment allowance,” “contracted rate,” or “negotiated rate.” HMAA’s payment is based on the eligible charge, not the billed charge. If the provider is not in our network, the rate is based on an established eligible fee schedule and you will be responsible for the difference between the billed amount and our payment.
Co-insurance is your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the eligible charge for the service. You pay co-insurance plus any deductibles you owe. For example, if your health plan’s eligible charge for an office visit is $100 and you’ve met your deductible, your co-insurance payment of 20% would be $20. The health insurance or plan pays the rest of the eligible charge.
A co-payment is a fixed amount (for example, $15) you pay for a covered health care service. The amount can vary by the type of covered health care service.
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 that your provider should charge you tax based on the eligible charge for the service and not the billed charge.
You must submit an application to enroll your newborn child within 31 days from his/her date of birth or adoption. If you do not add your newborn to your policy in that time frame, you will have to wait until the open enrollment period of your policy.
To enroll your child, you may download an enrollment application from our website or contact your employer for a form. Please confirm eligibility with your employer before enrolling a dependent for medical coverage.
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 charge, except for your 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 charge and the eligible charge, plus any co-payments, co-insurance, and deductibles. Therefore your out-of-pocket expense will be significantly higher. Please refer to our payment illustration or contact us for assistance.
Prior to scheduling your appointment, be sure to ask your doctor if he or she participates with HMAA. Or, search our provider directory.
You should locate a participating provider to access certain medical services, including emergency care, on the U.S. Mainland. We do not guarantee the availability of Mainland participating providers, including emergency care providers, in all areas. Our Mainland network does not apply to dental services.
Our Online for Members service enables you to view your benefit and claims information online. You may also view your deductible and stop loss accumulators, plan documents, and Explanation of Benefits (EOB) for paid claims, and request duplicate ID cards. Click on the following link to access your Online for Members account.
You do not need to register for this service. HMAA automatically provides members free 24/7 online access upon enrollment. Subscribers may login using the Insured ID that appears on their HMAA ID card. Dependents 18 years and older should refer to the letter we mailed at the time of enrollment for their login ID. Passwords are issued to all subscribers and dependents aged 18 and older at the time of enrollment or upon reaching age 18.
To request a new password, please call or contact our Customer Service Center.
Subscribers (covered employees) and dependents aged 18+ may view, print or download an image of their member ID card online using your Online for Members account login and password. To request a new ID Card online, please login to your Online for Members account or you may call or e-mail our Customer Service Center.
Subscribers (covered employees) and dependents aged 18+ may access their coverage information by logging into their Online for Members account. Once logged in, select the desired member to view, print or download an image of the Coverage Information page, which reflects the member’s name, member ID number, and coverage period, and can be used as evidence of coverage.
HMAA respects the privacy and confidentiality of protected and individually-identifiable health information (PHI and IIHI). Once a dependent turns 18 years old, his/her parent or guardian will no longer have the right to access the dependent’s health or insurance records without authorization from the dependent. This policy is in accordance with Federal and State confidentiality laws regarding health care and minors’ rights. Certain exceptions may apply.
Members may complete and submit a written authorization to authorize the disclosure of their personal health information to another person or entity.
HMAA’s health plans require precertification of certain services and supplies. We recommend that you view our precertification list, which is subject to change at any time. If you are under the care of a participating provider in Hawaii or on the Mainland, he or she will obtain approval for you. If you are under the care of a non-participating provider, you are responsible for obtaining prior approval by contacting our Customer Service Center. Failure to obtain pre-certification before obtaining medical services may result in a reduction of benefits.
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