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Frequently Asked Questions - FAQs
FAQs by Category
General
Benefits
Prescription Drugs
Retirees
Regarding New HMSA
Benefits
- Q: What is my coverage when I travel to the mainland?
A: HMA has national networks and an Akamai Way representative can provide participants with
instructions to their web site and help with locating providers in the area participants will be traveling or temporarily residing.
Please contact the Akamai Way at 954-8796 or toll free at 866-826-5335.
- Q: What is my coverage when I travel outside the U.S.?
A: Your benefits will be paid at the non-contracted benefit level. The provider may ask you
to pay upfront. Please send HMA your receipts along with any medical notes. Your receipts for services rendered must be in
English and converted into U.S. dollars.
- Q: What if my provider is not in the provider directory?
A: You may still see a non-contracted provider of your choice, however, your out of pocket expense
will be greater. HMA can send you, or you may obtain from the Web Portal, a Provider nomination form which we will forward to your
provider to request their participation in HMA’s network.
- Q: Is there an annual copayment maximum?
A: Yes, your annual copayment maximum is $2,500 per person per plan year. The plan year runs
from July 2009 to June 2010.
- Q: I have already reached my annual copayment maximum of $2,000 under HMSA through June 2009. Am I
responsible for another $2,500 for July – December 2009?
A: The annual copayment maximum under the Self Insured Medical Plan administered by HMSA was based
on a calendar year. The annual copayment maximum for the Self Insured Medical Plan administered by HMA is based on a plan year
(July 2009 – June 2010). Also, the trustees are looking into this issue to see what can be done for those that have reached or are
reaching that annual copayment maximum.
- Q: How much would I pay if I see a contracted doctor and my copay is 20%?
A: You would pay 20% of the eligible charge.
Example:
Doctor bills HMA $65.00 for an office visit.
The eligible charge is $65.00
HMA will pay 80% of the $65.00, which is $52.00
Member will pay 20% of the $65.00, which is $13.00.
- Q: How much would I pay if I saw a non-contracted doctor and my copay is 20%?
A: You would pay 20% of the eligible charge and any difference the provider may bill you over
the eligible charge.
Example:
Doctor bills HMA $100.00 for an office visit.
The eligible charge is $65.00
HMA will pay 80% of the $65.00, which is $52.00
Member will pay 20% of the $65.00, which is $13.00 plus the $35.00 difference between the doctor’s bill and the eligible charge.
- Q: Does the HSTA VEBA Trust self-funded plan have a pre-existing clause for participants?
A: There is no pre-existing clause for participants.
- Q: Are routine physical exams a covered benefit?
A: Yes, the benefit plan includes a routine physical exam subject to the annual allowance and
recommended screening tests for your age and gender.
- Q: Is there a waiting period for In Vitro Fertilization?
A: No, there is no specified “waiting period” for In Vitro Fertilization, but prior
authorization is required. However, there are criteria listed in the Summary of Benefits, and exclusions and limitations of In
Vitro. Please be aware that the member and spouse have a one-time In Vitro benefit limitation. Please call HMA at 954-8796 or
toll free at 866-826-5335 for prior autorization.
- Q: Are immunizations for travel covered?
A: Yes, However, only immunizations for travel that are listed in the plan are covered.
- Q: Does this plan cover airfare from neighbor islands if I need to see a specialist on Oahu?
A: Yes, subject to prior authorization and maximum allowances. Refer to the Travel Reimbursement
Benefit in the Summary of Benefits.
- Q: Does this plan cover colon cancer screening?
A: Yes, if this is a “wellness or preventive service,” the member’s age is within recommended
standards of care, and it’s ordered by a member’s physician. Under the current standards for colon cancer screening, it starts at
age 50 (no prior authorization needed). If the colon cancer screening is due to “illness or injury,” the diagnostic services are
covered by the plan regardless of age.
- Q: Are contraceptive injectibles covered – i.e. Depo-Provera?
A: Yes. Also, Depo-Provera does not require a prior authorization.
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