What you need to know
Our medical plans protect both your health and your finances. You can choose between two different plan options—an HMO and a PPO. The difference between them is how much you pay in payroll deductions, how much you pay out of pocket when you get care, and how much flexibility you have in choosing providers. The right plan for you is the one that best matches how you and your family use health care.
HMO option
You can choose to enroll in the Kaiser of Hawaii HMO option, which features:
A requirement to receive all care (except for emergencies) through HMO doctors, pharmacies, and facilities, and to get referrals to see specialists (except in-network ob-gyns).
No deductible for most services.
100% coverage for preventive care (no deductible or out-of-pocket cost to you for annual physical exams, lab tests, and age-appropriate screenings).
Office visits and prescription drugs covered in full after your copay.
Coverage for vision exams, lenses, and frames and an allowance for contact lenses.
An out-of-pocket maximum (the most that you’ll pay in a year for medical services) of $2,500 for individual coverage or $7,500 per family.
Note: Kaiser strongly encourages members to select a primary care physician.
Learn more about Kaiser.
What you pay for in-network care
| Plan features | Kaiser HMO |
|---|---|
| Deductible | None |
| Out-of-pocket maximum | $2,500 individual $7,500 family |
| Preventive care | You pay nothing |
| Office visits Primary care and specialist | $15 copay |
| Urgent care | $15 copay |
| X-ray and lab | 10% coinsurance |
PPO option
You can choose to enroll in a PPO medical plan administered by HMSA. This plan features:
The option to choose any doctor you want and self-refer to specialists, with discounted rates when you use health care providers in the HMSA network.
A low deductible ($200 for individual coverage or $600 for family coverage) that applies to both in- and out-of-network care.
100% coverage for preventive care (no deductible or out-of-pocket cost to you for annual physical exams, lab tests, and age-appropriate screenings).
Office visits and prescription drugs covered in full after your copay.
Other services, like hospitalization, x-rays and medical equipment covered at 80% after the deductible.
Coverage for vision exams, lenses, and frames with a copay, and an allowance for contact lenses.
An out-of-pocket maximum (the most that you’ll pay, including the deductible, in a year for medical services) of $2,200 for individual coverage or $6,600 for family coverage that applies to both in- and out-of-network care.
A separate out-of-pocket maximum for prescription drugs of $3,600 for individual coverage or $4,200 for family coverage.
What you pay for in-network care
| Plan features | HMSA PPO |
|---|---|
| Deductible | $200 individual $600 family |
| Out-of-pocket maximum* | $2,200 individual $6,600 family |
| Preventive care | You pay nothing |
| Coinsurance | 20% after deductible |
| Office visits Primary care and specialist | $12 copay |
| Urgent care | $12 copay |
| X-ray and lab | 20% after deductible Outpatient lab: You pay nothing |
* HMSA plans have a separate out-of-pocket maximum for prescription drugs of $3,600 individual and $4,200 family.
TRICARE Supplement Insurance
TRICARE is the Department of Defense’s health benefit program for the military community. TRICARE Supplement Insurance is a voluntary insurance plan designed to supplement your TRICARE benefits and help minimize health care expenses. Learn more about the program and determine your eligibility.
HMO medical plan
PPO Medical plan
Health and insurance information
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