FAQs: Members

A deductible is the amount you owe for services that your health insurance or plan covers before your health insurance or plan begins to pay. For example, if your deductible is $1,000, your plan won’t pay benefits until you’ve met your $1,000 deductible for covered services which are subject to the deductible. The deductible may not apply to all services.

This is the maximum amount on which payment is based for covered health care services. This may also be called “allowed amount,” “eligible expense,” “payment allowance,” “contracted rate,” or “negotiated rate.” HMAA’s payment is based on the eligible charge, not the billed charge. If the provider is not in our network, the rate is based on an established eligible fee schedule and you will be responsible for the difference between the billed amount and our payment.

Co-insurance is your share of the costs of a covered health care service, calculated as a percent (for example, 20%) of the eligible charge for the service. You pay co-insurance plus any deductibles you owe. For example, if your health plan’s eligible charge for an office visit is $100 and you’ve met your deductible, your co-insurance payment of 20% would be $20. The health insurance or plan pays the rest of the eligible charge.

A co-payment is a fixed amount (for example, $15) you pay for a covered health care service. The amount can vary by the type of covered health care service.

According to Hawaii State Law, general excise tax is an expense of doing business and is generally passed on to patients, which means that you are responsible for paying any applicable tax in addition to your co-insurance and co-payment. Please note that your provider should charge you tax based on the eligible charge for the service, and not based on the billed charge.

You must submit an application to enroll your newborn child within 31 days from his/her date of birth or adoption. If you do not add your newborn to your policy in that time frame, you will have to wait until the open enrollment period of your policy.

To enroll your child, you may download an enrollment application from our website or contact your employer for a form. Please confirm eligibility with your employer before enrolling a dependent.

Participating providers have agreed to render medically necessary services at negotiated rates. You are not responsible for the difference between the negotiated rate and the billed charge, except for your deductible, co-payments, co-insurance, and non-covered items.

HMAA has no agreement with non-participating providers. Therefore, you will be responsible for all non-covered charges including the difference between the billed charge and the eligible charge, plus any co-payments, co-insurance, and deductibles. Therefore your out-of-pocket expense will be significantly higher. Please refer to our payment illustration or contact us for assistance.

Prior to scheduling your appointment, be sure to ask your doctor if he or she participates with HMAA. Or, search our provider directory.

You should locate a participating provider to access certain medical services, including emergency care, on the U.S. Mainland. We do not guarantee the availability of Mainland participating providers, including emergency care providers, in all areas. Our Mainland network does not apply to dental services.

HMAA’s Member Online Portal enables 24/7 secure access to your benefit and claims information. You may also view your deductible and accumulators, plan documents, choose paperless Explanation of Benefits (EOB) for paid claims, and view or request duplicate ID cards. Click on this link to learn more about our online services.

HMAA’s Member Online Portal at https://hmaahealthplanportal.javelinaweb.com (for services rendered beginning January 1, 2024) enables you to self-reset your password by clicking the Forgot Username or Password link on the login page.

For the old HMAA Online for Members system at https://hmaaonline.com (for services rendered through December 31, 2023), contact our Customer Service Center to obtain your password.

Subscribers (covered employees) and dependents aged 14+ may login to the HMAA Member Online Portal to request a new ID card or view/download an image of their ID card. You may also contact our Customer Service Center for assistance.

Subscribers (covered employees) and dependents aged 14+ may access their coverage information by logging into the HMAA Member Online Portal and selecting the member. You may print or download an image of the Eligibility and Coverage Information page, which reflects the member’s name, ID number, and coverage period, and can be used as evidence of coverage. You may also contact our Customer Service Center for assistance.

Yes, you can request to stop receiving paper EOBs in the mail by logging into your HMAA online account at https://www.hmaahealthplan.javelinaweb.com and change your preferences to choose paperless EOBs.

HMAA respects the privacy and confidentiality of protected and individually-identifiable health information (PHI and IIHI). Once a dependent turns 14 years old, his/her parent or guardian will no longer be able to access the dependent’s health or insurance records without authorization from the dependent. This policy is in accordance with Federal and State confidentiality laws regarding health care and minors’ rights. Certain exceptions may apply.

Members may complete and submit a written authorization to authorize the disclosure of their personal health information to another person or entity.

HMAA’s health plans require precertification of certain services and supplies. We recommend that you view our precertification list, which is subject to change at any time. If you are under the care of a participating provider in Hawaii or on the Mainland, he or she will obtain approval for you. If you are under the care of a non-participating provider, you are responsible for obtaining prior approval by contacting our Customer Service Center. Failure to obtain pre-certification before obtaining medical services may result in a reduction of benefits.

For information about the Hawaii Prepaid Health Care Act, please visit Hawaii Prepaid Health Care Act. For information regarding the Affordable Care Act (ACA), please visit healthcare.gov.

Yes, please refer to our Commercial Medical Rx List which includes drugs that may require prior authorization.