Hawaii Medical Plans

2020 Plan Year Information

Hawaii Medical Plans

The Hawaii Medical Service Association (HMSA) and Kaiser Permanente (in-network only) coverage is available to employees located in Hawaii, based on home ZIP code.

HMSAKaiser Permanente
Note

The figures in the chart below reflect what the Plan pays, with the exception of deductibles and out-of-pocket maximums.

Individual Deductible

In-Network:
None

Out-of-network:
$100

None

Family Annual Deductible

In-Network:
None

Out-of-Network:
$300

None

Individual Out-of-Pocket Maximum

In-Network:
$2,500

Prescription coverage: $3,600

Out-of-Network:
$2,500

Prescription coverage: $3,600

$2,500

Family Out-of-Pocket Maximum

In-Network:
$7,500

Prescription coverage: $4,200

Out-of-Network:
$7,500

Prescription coverage: $4,200

$7,500

Most Preventive Care, Subject to Plan’s Frequency Limits

In-Network:
Covered at 100%

Out-of-Network:
70% of R&C after annual deductible

Covered at 100%

Office Visits (non-preventive)

In-Network:
100% after $15 copay

Out-of-Network:
70% of R&C after annual deductible

100% after $20 copay

Maternity

In-Network:
Inpatient: covered at 90%

Outpatient: 100%

Out-of-network:
70% of R&C after annual deductible

Delivery and all inpatient care: covered at 90%

Prenatal and postnatal care routine care: 100%

Fertility Coverage (includes cryopreservation, artificial insemination, IVF, GIFT and ZIFT)

In-Network:
Contact the plan for details about this coverage

Out-of-Network:
Contact the plan for details about this coverage

Contact the plan for details about this coverage

Medical Plan ID Cards

If you are enrolling for medical coverage for the first time or switching Plan administrators, you will receive a medical ID card by mail. If you require proof of coverage before receiving your ID card, you may print a temporary ID card from the Plan administrator’s website.