Hawaii - HMSA Bronze HMO

Hawaii, 2018

  • Plan Type

    HMO

  • Metal Tier

    Bronze

  • Out of Pocket Maximum

    $7,350

  • Deductible

    $6,000

Enroll Now
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Call (855) 866-5590 to speak with a licensed agent about a new health plan.

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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $6,000
Deductible (Family) $12,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,350
Out of Pocket Maximum (Family) $14,700

Doctor Visits

Primary Care Visit $40 Copay after deductible
Specialist Visit $60 Copay after deductible
Inpatient Facility $400 Copay per day after deductible
Inpatient Physician 40% Coinsurance after deductible
Emergency Room Services $250 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $400 Copay after deductible
Laboratory Outpatient and Professional Services $40 Copay after deductible
X-Ray and Diagnostic Imaging $40 Copay after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient No charge after deductible
Mental / Behavioral Health Outpatient 0% Coinsurance after deductible
Rehabilitative Speech Therapy $40 Copay after deductible
Rehabilitative Occupational & Physical Therapy $40 Copay after deductible
Outpatient Facility 40% Coinsurance after deductible
Outpatient Surgery 40% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx $50 Copay after deductible
Non Preferred Brand Rx $100 Copay after deductible
Specialty Drugs 20% Coinsurance after deductible

Other Plans in Hawaii

Plan HMSA Silver PPO 2000 Deductible $2,000 Coinsurance Not applicable Out of Pocket $7,350
Plan HMSA Platinum PPO Deductible $0 Coinsurance Not applicable Out of Pocket $7,150
Plan HMSA Gold PPO Deductible $0 Coinsurance Not applicable Out of Pocket $7,350
Plan HMSA Bronze PPO 7350 Deductible $7,350 Coinsurance Not applicable Out of Pocket $7,350
Plan HMSA Gold HMO Deductible $1,000 Coinsurance Not applicable Out of Pocket $7,350
Plan HMSA Catastrophic Plan Deductible $7,350 Coinsurance Not applicable Out of Pocket $7,350
Plan HMSA Gold PPO 1000 Deductible $1,000 Coinsurance Not applicable Out of Pocket $7,350
Plan HMSA Silver PPO 3500 Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,350
Plan HMSA Platinum HMO Deductible $0 Coinsurance Not applicable Out of Pocket $7,150
Plan HMSA Silver HMO Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,350
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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $6,000
Deductible (Family) $12,000
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,350
Out of Pocket Maximum (Family) $14,700

Doctor Visits

Primary Care Visit $40 Copay after deductible
Specialist Visit $60 Copay after deductible
Inpatient Facility $400 Copay per day after deductible
Inpatient Physician 40% Coinsurance after deductible
Emergency Room Services $250 Copay after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $400 Copay after deductible
Laboratory Outpatient and Professional Services $40 Copay after deductible
X-Ray and Diagnostic Imaging $40 Copay after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Not available
Pain Management Not available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient No charge after deductible
Mental / Behavioral Health Outpatient 0% Coinsurance after deductible
Rehabilitative Speech Therapy $40 Copay after deductible
Rehabilitative Occupational & Physical Therapy $40 Copay after deductible
Outpatient Facility 40% Coinsurance after deductible
Outpatient Surgery 40% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx $50 Copay after deductible
Non Preferred Brand Rx $100 Copay after deductible
Specialty Drugs 20% Coinsurance after deductible

Other Plans in Hawaii

Plan HMSA Silver PPO 2000 Deductible $2,000 Coinsurance Not applicable Out of Pocket $7,350
Plan HMSA Platinum PPO Deductible $0 Coinsurance Not applicable Out of Pocket $7,150
Plan HMSA Gold PPO Deductible $0 Coinsurance Not applicable Out of Pocket $7,350
Plan HMSA Bronze PPO 7350 Deductible $7,350 Coinsurance Not applicable Out of Pocket $7,350
Plan HMSA Gold HMO Deductible $1,000 Coinsurance Not applicable Out of Pocket $7,350
Plan HMSA Catastrophic Plan Deductible $7,350 Coinsurance Not applicable Out of Pocket $7,350
Plan HMSA Gold PPO 1000 Deductible $1,000 Coinsurance Not applicable Out of Pocket $7,350
Plan HMSA Silver PPO 3500 Deductible $3,500 Coinsurance Not applicable Out of Pocket $7,350
Plan HMSA Platinum HMO Deductible $0 Coinsurance Not applicable Out of Pocket $7,150
Plan HMSA Silver HMO Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,350