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Medical

We’re proud to offer you the HMSA medical plan to help you and your family get the care you need, when you need it. 

With the HMSA Medical Plan, you have the freedom to receive care from any licensed provider.

However, you generally pay less when you receive care from doctors, hospitals and other health care facilities that participate in the HMSA network and have agreed to provide services to plan members at special discounted rates.

Services within the HMSA Medical Plan require a copay except for some that have a listed coinsurance. Once you’ve met the deductible, you’ll pay a percentage of the cost for services with coinsurance.

This chart summarizes the medical coverage provided by HMSA. All covered services are subject to medically necessity as determined by the plan. Services within the HMSA Medical Plan require a copay except for some that have a listed coinsurance. Please be aware that all out-of-network services are subject to Reasonable and Customary (R&C) limitations.

Plan Features HMSA
In-Network Out-of-Network
Annual Deductible
Individual/Family		 $200 / $600* $200 / $600*
Medical Annual Out-of-Pocket Maximum
Individual/Family		 $2,200 / $6,600** $2,200 / $6,600**
Pharmacy Annual Out-of-Pocket Maximum
Individual/Family		 $3,600 / $4,200 $3,600 / $4,200
  Amount you pay:
Preventive Care Covered in full Covered in full
Telemedicine/Virtual Covered in full Covered in full
Primary Care $12 copay $12 copay
Specialist $12 copay $12 copay
Lab & X-ray 20% after deductible 20% after deductible
Urgent Care $12 copay $12 copay
Emergency Room $12 physician copay (if applicable) + 20% after deductible
Inpatient/Outpatient Hospital 20% after deductible 20% after deductible
Inpatient Mental Health 20% after deductible 20% after deductible
Outpatient Mental Health Covered in full Covered in full
Acupuncture, Chiropractic, & Therapy   $20 copay
(up to 24 visits)		 Amount over $30 allowance
(up to 12 visits)
Prescription Drugs: Retail (up to a 30-day supply) Deductible does not apply
Generic $7 copay $7 copay + 20% coinsurance
Preferred $30 copay $30 copay + 20% coinsurance
Non-preferred $30 copay + $45 Tier 3 cost-share $30 copay + $45 Tier 3 cost-share + 20% coinsurance
Preferred Specialty 20% coinsurance Not covered
Non-preferred Specialty 25% coinsurance Not covered
Prescription Drugs: Mail Order (up to a 90-day supply) Deductible does not apply
Generic $11 copay Not covered
Preferred $65 copay Not covered
Non-preferred $65 + $135 Tier 3 cost share Not covered
Preferred Specialty Not covered Not covered
Non-preferred Specialty Not covered Not covered

*Family deductible is $200 per individual up to $600 per family.
**Family OOPM is $2,200 per individual up to $6,600 per family.

If you take a maintenance prescription drug, you may be able to get a 90-day supply for less than the cost of three 30-day refills. With FREE shipping, it shows up at your front door, so you can skip the trip to the pharmacy. 

Sign up for Mail-Order Delivery:

  1. Go to Mail-Order Prescription Drug Program.
  2. Click CVS Caremark Mail Service Order Form to download and complete the Mail Service Order Form.
  3. Mail the completed form, along with your prescription and payment to:
    CVS Caremark
    P.O. Box 30980
    Honolulu, HI 96820-9930

Rx Savings Solutions specialists are here to lend a hand in reducing your prescription costs by researching options to find the optimal savings options tailored to you. Plus, they will work with your doctor and pharmacy to ensure you get the greatest savings possible. This FREE service is available to all FBM employees regardless of which medical plan you are enrolled in.

To activate your account, please visit auth.rxsavingssolutions.com/activate.

HMSA Online Care

Experience Convenient Healthcare with HMSA’s Online Care. Connect with a physician online, eliminating the need to drive to your doctor, an urgent care center, or the emergency room. All you need is an Internet-accessible computer and a webcam, phone, or tablet.

Here’s how it works:

  1. Access care anytime: Log in to HMSA Online Care at any time for assistance with urgent, non-life-threatening medical needs. You will be connected to an HMSA doctor via webcam.
  2. Consult with a doctor: The doctor will listen to you, ask questions about your medical condition, and provide a diagnosis.
  3. Prescription services: In some states, the doctor may be able to prescribe basic medications if necessary.
  4. Electronic prescriptions: If a medication is prescribed, the doctor will send an electronic prescription to your pharmacy.

Note: You must be in Hawai’i to use HMSA’s Online Care. To learn more or to register, visit HMSA Online Care.

Telehealth/Virtual Visit Primary Care Provider (PCP)
Time: Low | Cost: $ Time: Low | Cost: $

Benefit:

  • Lower cost
  • Speak to a doctor from anywhere
  • Reduced waiting room time

Reasons to go:

  • Treatment of minor injuries and illnesses
  • Limits exposure to contagious diseases
  • May receive specialist referrals or prescriptions

Benefit:

  • In-person examination
  • Reasonable price in-network
  • Familiarity with health history

Reasons to go:

  • Preventive care
  • Treatment of chronic illnesses
  • Follow-up visits and referrals
Urgent Care Center Emergency Room
Time: Mid-range | Cost: $$ Time: High | Cost: $$$$

Benefit:

  • Lower cost than an ER visit
  • Same-day visits are often available

Reasons to go:

  • Medical conditions that need prompt attention
  • Treatment of minor injuries or illnesses
  • May offer lab tests and X-rays onsite 

Benefit:

  • Necessary for life-threatening conditions

Reasons to go:

  • Sudden onset of severe medical condition
  • Treatment of severe injuries or illnesses
  • Treatment after an accident

Contacts

(808) 948-6111
HMSA.com

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(800) 268-4476
Monday – Friday
2:00 AM – 3:00 PM HST
support@rxsavingsolutions.com
Activate your account: auth.rxsavingssolutions.com/activate