- HMSA.com
Contents
1. You ve joined a health plan You ve joined a health plan which means you ve made an invest ment in your health And with HMSA you ve got a plan that s working day and night to make that investment pay off Because HMSA isn t just another health plan we re an extended ohana that s working together to improve the health of our entire state Hawaii is our home its people are our family and caring for you is why we re here THANK YOU FOR CHOOSING HMSA AND WELCOME TO THE HMSA FAMILY how can we help you be as healthy as possible There are lots of answers and most of them lead to one conclu sion We re in this together You your doctors and your health plan have to work together to make a difference in your life To do that we have to know and trust each other This user s manual is Tull of Important information about your health plan It s a good place to start your journey to healthy as can be We ll make sure you have everything you need to address your health issues and take advantage of opportunities to improve And we ll always give you our best whenever you need us Being healthy is a lifelong pursuit but you don t have to do it alone We re here to help you This brochure gives you an overview of HMSAs most common plans and answers basic health plan questions It doesn t replace your Guide to Benefits which has the details about your plan If you have questions about your plan2. Our mission is to provide the people of Hawaii access to a sustainable quality health care system that improves the overall health and well being of our state hmsa DN ee a Ga hmsa com 08 1000 3198 1 15 AM
3. Se If you don t see a link to view your dental or drug claims check your HMSA membership card to see if you have dental or drug coverage with HMSA If you don t see the word Dental or Drug with a code next to It check with your employer or employee organization to see if you have coverage under another insurer If your HMSA membership card shows that you have dental or drug coverage with HMSA and you don t see a link to view those claims call a Customer Relations representative Phone numbers are on page 16 To print a copy of your HMSA membership card hover over Profile on the top right of the page and click View ID Card To view your Guide to Benefits hover over Benefits at the top of the page and select Medical Benefits in the drop down menu 2 i ey ee NE mS Ps Se ee es imma ea e i m BEI SLE 2 ge A ee es call Then click the download icons to view your drug medical and or vision coverage Your Guide to Benefits is a legal document that includes important information about your plan benefits limitations and exclusions Eeri R0000XXXXXXXX mee Seeds en e m Not all plans have a Guide to Benefits available online If yours isn t and you want a hard copy call Customer Relations Phone numbers are on page 16 m gir Gels dim bie l d e o i o eola Piia e er ee bi lia a a a z 5 F Guide to L Bomerits F Guide to a m Metts oft h PiusHealth Plan Hawai HMO Hawa
4. we want to help Please call us phone numbers are on page 16 contents Quick start tips 2 Using your plan while traveling 10 Basic health plan terms 3 Using Well Being Connect 11 Your HMSA membership card 4 How to update your address 12 How to use My Account 5 Appealing an HMSA decision 12 Choosing or changing your PCP 8 Additional member benefits 13 Contact HMSA 14 _ Ee quick start tips BR There s no right or wrong way to use your health plan but we have a few tips to help you get the most out of it o Be yourself Make sure the information on your membership card is correct and up to date If it s not please let us know There s more about your card on page 4 e Be accountable Sign up for My Account on hmsa com so you can take advantage of all its online features Check out page 5 to learn about them e Stay on the map it s hard for us to provide you with quality care if we re missing certain information That s why we ll contact you to get your Social security number and other important information Represent If you want somebody like a parent or spouse to be able to see your eligibility billing payments claims and medical information and make appeals on your behalf send us an Authorized Representative Form Search for Authorized Representative Form on hmsa com e Say hello doctor Having a trusting relationship with a primary care provider PCP is your ticket to optimal healt
5. basics You can find an even bigger list if you search for glossary on hmsa com Your HMSA membership card is your ticket to health care telling providers what type of plan you have and how to file your claims It s a good idea to carry your card with you especially when you travel You can print a copy of your card or ask for a replacement through My Account on hmsa com If your plan information changes we ll send you a new card and you can throw away your old one We ll also send new cards for your covered spouse and dependents oy hmsarF n ee g Subscriber N am KIMO K ALOHA Group 58035 Subscriber ID XLHR001 Membe h Sa g KEIKI K Y a e ee ay g Subscriber N ame IMO K ALOHA Group 14520 eg Subscrib er ID lealth Plan Hi XLPR001234567899 Member Name 04 KEIKI K ALOHA a ie DENTAL V03 a Ay VISION OAI RXPCN A4336 RXGRP RX3989 a PC how to use My Account My Account on hmsa com is your home base for personalized information about your health plan Use it to e Get a copy of your HMSA membership card e Change your email preferences or password e Use HMSAs Online Care to visit a doctor online see page 10 for more information e See your claims information we ll explain more a little later People with Akamai Advantage plans don t have this feature on My Account but you can call us and we ll help Phone numbers are on p
6. 18 Keeaumoku St Monday through Friday 8a m 6 p m Saturday 9 a m 2 p m HMSA Center Pearl City Pearl City Gateway 1132 Kuala St Suite 400 Monday through Friday 9a m 7 p m This brochure includes general informa Saturday 9 a m 2 p m tion about HMSA plans Your plan provides many benefits in specific HMSA Center Hilo situations such as when you re away Waiakea Center from Hawaii and if you have more than 303A E Makaala St one insurance plan For details see your Monday through Friday Guide to Benefits or visit hmsa com 9a m 7 p m And you can always call Customer Saturday 9 a m 2 p m Relations Phone numbers are on page 16 see hmsa com contact for our holiday schedule NEIGHBOR ISLAND OFFICES HMSA representatives are available in person from 8 a m to 4 p m Monday through Friday ONLINE hmsa com SOCIAL MEDIA facebook com myhmsa Kailua Kona facebook com islandscene Hawaii Island 75 1029 Henry St Suite 301 Kailua Kona HI 96740 AskHMSA Phone 329 5291 HMSAislandscene Lihue Kauai 4366 Kukui Grove St Suite 103 Lihue HI 96766 askhmsa Phone 245 3393 Kahului Maui 33 Lono Ave Suite 350 Kahului HI 96732 Phone 871 6295 MAIL General HMSA PO Box 860 Honolulu HI 96808 Claims Medical and Physician Claims HCFA 1500 PO Box 44500 Honolulu HI 96804 4500 Dental Claims PO Box 1320 Honolulu HI 96807 1320 Hospital Claims U
7. B 92 PO BOx32700 Honolulu HI 96803 2700 Out of State Claims PO Box 2970 Honolulu HI 96802 2970 Appeals HMSA Attn Appeals Coordinator PO Box 1958 Honolulu HI 96805 1958 PHONE HMSA representatives are available on the phone from 8 a m to 5 p m Monday through Friday unless otherwise noted Got Questions Dental Services Oahu 948 6111 Oahu 948 6440 Molokai 1 800 639 4672 Neighbor Islands 1 800 792 4672 Maul 8 1 6295 Lanal 1 800 639 4672 Individual Plan Billing Kaual 245 3393 Oahu 948 6140 Kailua Kona Hawaii 329 5291 Neighbor Islands 1 800 782 4672 Hilo Hawalli 935 5441 _ Fraud Hotline Confidential Group Individual PPO Plans Oahu 948 5166 Oahu 948 6111 Neighbor Islands 1 888 398 6445 Neighbor Islands 1 800 776 4672 HMSA s Online Care Support HMO Health Plan Hawaii Plans Available 24 hours a day seven days a week Oahu 948 6372 Oahu 948 6013 Neighbor Islands 1 800 776 4672 Neighbor Islands 1 866 939 6013 Additional customer service numbers Compliance amp Ethics Privacy amp Security Incident Hotline Confidential 1 800 749 4672 toll free HMSA Well Being Connect Support 1 855 329 5461 toll free Corporate Telephone Operator 948 5110 on Oahu b Employment Office 948 5588 on Oahu Text Telephone TTY 711 gt We hope this brochure helps you understand how your health plan works Thanks again for choosing HMSA hmsa DWN Gee a Vann
8. age 16 e f you have a drug plan there are tools to make life easier like ordering refills online that can be mailed to your home himsa rag Create an account To log in or register for My Account go to hmsa com and aa click Member Login at the top of the screen e f you re logging in enter your information and click Login Puuna BE e f you re registering click Create an account Then Y becherecters v poskea V enbi enter a valid email address create a password and click Sy cing Consta you mapi U Tan ad ariin iar tha My Create account aari To view your current or past plans log in to My Account and click Add a plan Enter your name birth date and the subscriber ID on your HMSA membership card and then click Link plans To view claims information log in to My Account and hover over Medicalf Claims on the top of the page Select medical dental or drug claims in the drop down menu On the Medical Claims page you ll see a summary of your medical and vision claims and your Report My Account oT to Member statements RIMs Please note that Akamai Advan tage members can t view their medical claims information on My Account If you need information or help call us Phone numbers are on page 16 Well Being Connect Do you know how healthy you are Take short survey and see where you stand Then create a plan with goals to improw your well being and get the support you need to achieve those goals
9. age and click Edit Profile e Then click Edit in Mailing address Till out the form and click Submit Some employers don t let you report address changes to HMSA so please check with them first If they don t ask them to notify HMSA of your change If you bought your plan on the Hawai i Health Connector contact the Hawai i Health Connector to change your address appealing an HMSA decision If you disagree with a decision HMSA has made about your plan coverage reimbursements to you or your doctor or other decisions you can file an appeal with HMSA to review the decision When you Tile an appeal we review all the available information and make sure that the rules of your plan were followed After the review your appeal will either be approved or denied and both you and your provider will be notified of the decision If your appeal is denied you ll receive a letter explaining why You can find detailed instructions on how to file an appeal in your Guide to Benefits If you have questions about appeals call Customer Relations Phone numbers are on page 16 D additional member benefits Your health plan has a lot to offer beyond doctor s visits Check out these added benefits that can help you live a healthy lifestyle and stay in touch with your doctors HMSA s Online Care island scene HMSAs Online Care lets you see a doctor any Every quarter we ll mail you our member maga where anytime on your smar
10. h so you should get on that right away If you don t have a PCP you can use hmsa com s Find a Doctor tool to find one See instructions on page 8 e Parlez vous medicalaise At times we use industry terms Sorry We try to be as plain and simple as possible but sometimes Jargon is efparameunt ttHty unavoidable So we put together a section that explains different types of health plans and basic health care terms on the next page e Know where to turn for help there s a list of our most commonly used contact information starting on page 14 including our HMSA Centers if youd like to see us In person A basic health plan terms eeeccccce esososooo eesoooooo eeseooooo Claims Forms to ask for payment from your health plan for a covered service Our participating providers submit claims for you but some nonparticipating providers might bill you directly and you ll have to submit a claim to HMSA Copayment The amount you pay participating providers for covered medical services and products like a doctor s visit or prescription drugs after you meet your plan deductible if your plan has one Covered services Health care services that your plan pays for based on your plan benefits Even if your plan covers a service you may have to pay a copayment or deductible Deductible The amount you pay each year before your plan starts paying for covered services Drug formulary A list of generic and brand name prescrip
11. ii Health Plan Hawaii To manage your prescription drugs hover over Drugs at the top of the page and click Drug Summary This page has many tools and resources including e Dashboard Go to your CVS Caremark member home page to print forms get messages from CVS Caremark use Ask a Pharmacist and more e Drug claims View processed claims and mail order payment information e Pharmacy locator Find a pharmacy in your area that s in HMSAs network e Manage drugs online Order prescription refills and view your prescription history e Benefits Compare pharmacy and mail order copayments to see where you Can Save Drug pricing Check drug coverage and cost and view brand name and generic drug copayments e Order drugs online Save time and money with mail order prescription drugs e Drug order status See where your drugs are and set up automatic refills and renewal My Account is a great resource for information so we hope you ll register and use it often If you have questions about My Account call Customer Relations and we ll help you get squared away Phone numbers are on page 16 choosing or changing your PCP Choosing a PCP is one of the most important things you can do for your health It s called primary care because It s of primary importance having a doctor who knows you well and can coordinate care to meet your needs leads to better care better health and better value for your health ca
12. nature When in a foreign country please try to get all of the information in English and costs in U S dollars if possible Send your claim to Out of State Claims PO Box 2970 Honolulu HI 96802 2970 E gt using well being connect Gain perspective empower yourself and achieve greater well being with Well Being Connect You can get started in two ways 1 Login to hmsa com wbce and click I m an HMSA member 2 Login to My Account and click Well Being Connect Once you re on the Well Being Connect website start your journey toward a more balanced life by taking the Gallup Healthways Well Being 5 survey The survey gives you a complete picture of your overall health Next create a Well Being Plan to help you set goals to strengthen areas that can improve your well being You ll also find tools on the site to Support you throughout your well being journey such as e Progresii ckers e Personal daily activities journal e Articles and videos e Healthy recipes and meal plans Go to hmsa com wbc to get started If you have questions about Well Being Connect call the Well Being Connect Support line on page 16 Gallup Healthways Well Being 5 All rights reserved how to update your address If your employer lets you report address changes to HMSA or you have an individual plan you can update your address on My Account e After you log in hover over Profile at the top right of the p
13. re dollar Having a PCP is a great way to build a trusting relationship with a doctor and make the most of your plan s coverage And finding one is easy with Find a Doctor Use the Find a Doctor search engine on hmsa com to find a participating provider or dentist Fiaa abar You can search by name location specialty including PCP or ailment and narrow your results based on gender languages spoken and plan oor one bha cour The number of patients a PCP can have is limited so TEREE call the PCP you re interested in and ask if they re ie E accepting new patients You can also get a hard copy __ rei Hamr eraa nay of our directory of participating providers just call Dent pe es no Bl Customer Relations Phone numbers are on page 16 S m When searching for a PCP here are some things to consider depending on your plan type a re E e HMO plan members You must choose a a a PCP and health center so make sure the CNA AN provider and health center you choose participate Fina i 7 with your plan You can select your plan in the box or Deets next to the search field at the top of the Find a mini ara E Doctor search engine rion e PPO plan members You don t have to e Ceres atari Hy choose a PCP but it s highly recommended l F And choosing participating providers will save you money Your PCP wants you to be your healthiest b
14. tion drugs that your drug plan covers Eligible charge The amount that participating providers agree to charge for covered services Nonparticipating providers can charge as much as they want so even if services you get from them are covered your plan will only pay the eligible charge and you ll have to pay the rest Health maintenance organization HMO A type of health plan that lets you pick one health center and a PCP within that health center to provide all of your care Network The collective term for all of the providers who participate with a health plan Participating provider Providers in our network who agree to charge plan mem bers a lower rate than nonmembers It s kind of like a wholesale rate see a participating provider and you ll pay less Nonparticipating providers don t have an agreement with us and may charge as much as they want which can be more than what your plan will cover also Known as the eligible charge Preferred provider organization PPO A type of health plan that lets you see any provider you prefer in HMSAs net work of participating providers Primary care provider PCP Your main doctor who coordinates your care Provider Someone who provides health care We often say provider because doctor isnt technically accurate You might see a nurse physical therapist physician s assis tant lab technician or many other health care providers who arent doctors These are the
15. tphone or tablet for zine Island Scene which is packed with articles on medical advice referrals and prescriptions And health fitness family and member news You could you don t need an appointment even be in the magazine if you have an interesting r ll or reci hare e o download the mobile app PEE ETO ET ACE p go to the Apple App Store or Google Play You can read archived issues and articles on islandscene com If you ve got an idea for a story a recipe to share questions about the magazine go to islandscene com click About then Contact Us and fill out the feedback form Y COZEVA Everybody loves to save money HMSA365 gives Cozeva is an online tool that lets you easily manage you discounts on health and wellness products health care for yourself and everyone in your family and services like LASIK surgery massage therapy With Cozeva you can and exercise classes e o register on your computer or learn more go to hmsa com onlinecare Go to hmsa com hmsa365 for a full list of e View HMSA health information for you and discounts or call 1 866 520 6362 toll free for more information e See your immunization history your family e Get a list of your past and current medications e And more Check Cozeva s Doctor Directory at cozeva com or call your doctor to see if they participate in Cozeva EEE contact HMSA HMSA CENTERS get complete plan details HMSA Center Honolulu 8
16. ut can t do it without your help If you have questions during a visit with your PCP just ask Make sure you ask these three questions whenever you see your doctor e What s my number one concern e What should I do e Why should I do this If it s hard for you to ask questions make a list of health concerns to discuss with your PCP If you re an HMO member and want to change your PCP make sure your new PCP is accepting new patients and then call 948 6372 on Oahu or 1 800 776 4672 toll free on the Neighbor Islands You can also mail a request to Health Plan Hawai Customer Relations Department HMSA PO Box 860 Honolulu HI 96808 0860 F y Bi e g a D using your plan while traveling Before your trip Find out how your plan will work when you re away from home by giving us a call at one of the plan numbers on page 16 Find the names of participating providers in the area you re visiting by calling 1 800 810 BLUE 2583 toll free If you need to see a doctor on your trip Call BlueCard at 1 800 810 BLUE 2583 toll free on the Mainland or 804 673 1177 If you re in another country for more information If you need to pay for care at the time you receive it Getting the following information will helo us with your claim e Date of service e Diagnosis e Procedure code e temized charges e Description of service e Receipt e Address where the service was provided e Physician s name and sig
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