2021 Summary of Benefits · 2021. 1. 15. · PET scans. • Therapeutic radiology services such as radiation treatment for cancer. $0 • Medically necessary diagnostic or therapeutic

H3832_1099_2025_247756_M

This is a summary of health services and drug benefits for HMSA Akamai Advantage® Dual Care (PPO SNP) plan effective Jan. 1, 2021.

HMSA Akamai AdvantageDual Care (PPO SNP)

Your Guide to Choosing a Medicare Advantage

Plan

2021 Summary of Benefits

1

Get More Benefits ........................................................................ 2

Eligibility and Important Dates ................................................... 3

Get More with HMSA Akamai Advantage Dual Care .............. 4

Summary of Benefits .................................................................... 6

Medications ................................................................................ 15

Need Help Paying for Your Medications? ............................... 16

Enrollment ................................................................................... 17

Care Coordination .................................................................... 18

Pre-enrollment Checklist ........................................................... 19

Multi-language Interpreter Services ........................................ 20

Contact Us ................................................................... Back cover

What’s inside

Get more benefits for $0.

2

Smile more. Dental services include exams, cleanings, X-rays, fillings, and more.

Save money. Get $75 every three months to spend on CVS health and wellness products.

Choose your doctors. Get the care you need from the doctors you choose.

Get care from home. Connect with doctors online or by phone with telehealth, including HMSA’s Online Care®.

Get support. A personal care coordinator will look out for your health and well-being.

Connect with us. We’re ready to help you on the phone or in person.

Amwell® is an independent company providing hosting and software services for HMSA’s Online Care platform on behalf of HMSA.

3

IMPORTANT:If you have a state or county retiree plan or employer-sponsored retiree plan, talk to your health plan administrator at work before enrolling in HMSA Akamai Advantage. You may not need to enroll in HMSA Akamai Advantage. Also, if you enroll in Medicare Advantage (MA), you may lose your state or county retiree plan and may not be able to re-enroll. If you have a federal plan, you may enroll in HMSA Akamai Advantage. However, you may still have out-of-pocket costs.

It’s our privilege to serve you. To enroll in HMSA Akamai Advantage Dual Care, you must meet all of these requirements:

• Live in Hawaii.

• Have Medicare Part A (hospital insurance), Part B (medical insurance), and full Medicaid benefits.

• Pay your Medicare Part B premium if Medicaid or another source doesn’t already pay for it.

• If you miss the annual Medicare enrollment period, don’t worry. You may be able to enroll during the year. Contact us for more information.

Still not sure if you’re eligible? Let us know so we can help you. See our contact information on the back of this brochure.

Eligibility

2020

OCTOBER

2020

DECEMBER

2021

JANUARY

Your plan will start:Annual Medicare Enrollment Period

Important dates to remember

4

Choose your doctors

You have access to a large provider network. With primary care providers (PCPs), nurse practitioners, specialists, and other providers, you’re sure to find the care you need. To find a provider, go to hmsa.com and click Find a Doctor at the top.

Care team on your side

You’ll work with a care coordinator or registered nurse to create a personalized care plan to help you achieve your health goals. See page 18 to learn more.

Dental care

Because oral care is part of overall good health and well-being, you’ll receive benefits for dental exams, cleanings, X-rays, fillings, and more.

Go shopping

Save money on health and well-being products mailed to your home. You’ll get $75 every three months to order CVS health-related items.

Quick access to care

Get care from the comfort and privacy of your home with telehealth services, including HMSA’s Online Care, at no cost. For hours of operations, check with the telehealth provider. You can also see a nurse or other health care provider at your nearest walk-in CVS/minuteclinic® at selected Longs Drugs stores.

All the benefits of Original Medicare and so much more.

Get more with HMSA Akamai Advantage Dual Care

http://hmsa.com

5

Preventive care

Your health is important to us. That’s why we make sure that you have access to preventive services to keep you at your healthy best. With HMSA, an annual wellness visit and many preventive care services are available at no cost.

Health education workshops

Attend a variety of health education workshops at no cost to learn how to sleep better, make healthier food choices, stay active, and more. Check hmsa.com/well-being/workshops for schedule, locations, and safety details.

Health coaching

Get guidance, support, and resources to help you manage chronic health conditions, stop smoking, relieve stress, and more.

http://hmsa.com/well-being/workshops

6

* For some services, your doctor or other network provider must request prior authorization. Please contact us for more information.

Benefits HMSA Akamai Advantage Dual Care (PPO SNP)

HMSA QUEST Integration

YOU PAYMonthly premium

You must continue to pay your Part B premium in addition to your HMSA premium.

$0 $0

Annual deductibleWhat you’ll have to pay each year out of pocket before the plan will pay for some services.

$0 (in-network)$1,408 (out-of-network)

For Medicare Part A covered services

$198 (out-of-network)For Medicare Part B

covered servicesThese amounts may change in 2021.

$0

Maximum out-of-pocket This financial safety net protects you from a catastrophic illness. It’s the most you’ll pay out of pocket for Medicare-covered medical services each year.

$6,700 per year (in-network)

$10,000 per year (in-network and out-of-network)

$0

Inpatient hospital care* Days 1-90: $0 per day (in-network)

$1,408 deductible and Days 1-60: $0 per day

Days 61-90: $352 per day (out-of-network)

(continued)

$0

Your share of the cost:

$ = Copayment. A set dollar amount that you pay. % = Coinsurance. The percentage of the cost that you pay.

Summary of Benefits HMSA Akamai Advantage Dual Care

Here’s a short description of the 2021 benefits of HMSA Akamai Advantage Dual Care and HMSA QUEST Integration plans and the amount you’ll pay. There may be some exceptions, so check the Evidence of Coverage for details. Your costs may change or be different depending on how much you receive in Extra Help (see page 16) or if you have Medicaid with a health plan other than HMSA. If you have any questions, please contact us so we can help you.

7




YOU PAYInpatient hospital care* (continued)

Lifetime Reserve Days (60): $704 per day

These amounts may change in 2021.Outpatient hospital services* $0 (in-network)

30% of the cost (out-of-network)$0

Ambulatory surgery center services*

$0 (in-network)30% of the cost (out-of-network)

$0

Doctor’s office visits


$0 Includes physical exams

and screenings

• Primary care provider (PCP)A physician or other health care professional who treats common illnesses and manages your preventive care.

• Advanced practice registered nurse, nurse practitioner, or physician’s assistant



and screenings

• SpecialistA physician who treats specific conditions such as allergies, heart disease, or foot disorders.



and screenings

Preventive care $0 (in-network and out-of-network)

• Annual wellness visits.• Annual physical exam.• Bone mass measurements.• Diabetes screenings.• Mammograms.• Some vaccines such as flu

shots, hepatitis B shots, and pneumococcal shots.

For a complete list of preventive care services, please see the

Evidence of Coverage.

$0 for routine adult care

• Blood pressure check.• Cholesterol level blood test.• Colorectal cancer check by

sigmoidoscopy or fecal occult blood test.

• Mammogram with or without a breast exam.

• Pap test and pelvic exam.(continued)

8



YOU PAYPreventive care (continued)

$0 for routine preventive care for children younger than age 21.

• Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) services include regular checkups and shots. Referrals to specialists for problems found during an EPSDT exam.

Emergency careYou won’t pay a copayment for emergency care if you’re admitted to the hospital within 24 hours.

$0 (in-network and out-of-network)

$0

Urgent careYou won’t pay a copayment for urgent care if you’re admitted to the hospital within 24 hours.

$0 (in-network and out-of-network)

$0

Diagnostic services, labs, and imaging*


• Diagnostic tests and procedures, lab services, and outpatient X-rays.

• Diagnostic radiology services including advanced imaging services such as MRI, CT, and PET scans.

• Therapeutic radiology services such as radiation treatment for cancer.

$0• Medically necessary diagnostic

or therapeutic radiology or lab services.

• Sleep lab tests to diagnose sleep-related disorders.

Summary of Benefits (continued)


9



YOU PAYHearing services $0 (in-network)

30% of the cost (out-of-network)Exam to diagnose and treat hearing and balance-related conditions. Doesn’t include routine hearing exams or hearing aids.

$0• Ear molds. • Hearing aid batteries.• Hearing exam.• Bilateral hearing aids with

standard features.

Dental services $0 (in-network)30% of the cost (out-of-network)

• Services by a dentist or oral surgeon, limited to surgery of the jaw or related structures, setting fractures of the jaw or facial bones, extraction of teeth to prepare the jaw for radiation treatments of neoplastic disease, or services that would be covered when provided by a doctor.


• Preventive and additional com-prehensive dental services every calendar year:

- Two oral exams - Two cleanings - Two fluoride treatments - One set of bitewing X-rays - One full mouth or panoramic X-rays every five years

- One filling per tooth surface - One root canal per tooth - One periodontal scaling and root planing procedure per quadrant

(continued)

$0• Dental or medical services in

a hospital or surgery center as a result of a dental or medical condition.

• Emergency services by a dentist or oral surgeon and physicians such as plastic surgeons, otolaryngologists (ear, nose, and throat doctors), and general surgeons due to a traumatic injury such as a car accident.

10



YOU PAYDental services (continued)

- Two denture adjustments - One simple denture repair per arch

The plan covers up to $2,500 per year for preventive and additional

comprehensive services.

Vision services $0 (in-network)30% of the cost (out-of-network)

• Eye exam to diagnose and treat eye diseases and conditions including yearly glaucoma screening

• Eyeglasses or contact lenses after cataract surgery

$0• Eye exams to test for refraction.• Eyeglasses to correct vision.

Mental health care Days 1-90: $0 per day (in-network)

$1,408 deductible and Days 1-60: $0 per day

Days 61-90: $352 per day (out-of-network)

Lifetime Reserve Days (60): $704 per day

Includes mental health care services that require a hospital stay.

These amounts may change in 2021.

$0Services for inpatient psychiatric hospitalizations include:• Psychiatric services.• Substance abuse treatment.

• Inpatient visit*

• Outpatient therapy visits $0 (in-network)30% of the cost (out-of-network)

Individual and group visits.

$0Outpatient mental health services include:• Ambulatory mental health

services.• Crisis management.• Day treatment.

(continued)



11



YOU PAY• Outpatient therapy visits

(continued)• Medications and medication

management.• Methadone management.• Psychiatric or psychological

evaluation and treatment.• Treatment for medically

necessary alcohol and chemical dependency.

Skilled nursing facility* Days 1-100: $0 per day (in-network)

Days 1-20: $0 per day Days 21-100: $176 per day

(out-of-network)Our plan covers up to 100 days in a skilled nursing facility. No prior Medicare-covered acute level of

care hospital stay is required.These amounts may change in 2021.

$0

Outpatient rehabilitation* $0 (in-network)30% of the cost (out-of-network)

• Occupational therapy visit.• Physical therapy. • Speech and language therapy

visit.

$0Services include assessment and treatment for problems with:

• Communicating.• Doing everyday tasks.• Memory.• Paying attention.• Thinking.

Rehabilitation services include:• Corrective surgery.• Durable medical equipment

(DME).• Medical supplies.• Occupational therapy.

(continued)


12



YOU PAY

• Physical therapy.• Prostheses and orthoses.• Respiratory services.• Speech therapy.

Habilitation services that develop, improve, or maintain skills for daily living include:• Audiology services.• Devices to help communicate,

read, and see.• Occupational therapy.• Physical therapy.• Speech therapy.• Vision care.

Ambulance Ground and air ambulance


$0

Transportation Not covered $0Non-emergency transportation services when your medical condition requires treatment that isn’t available in your area.• Air transport.• Ground transportation.• Taxi service.

Medicare Part B drugs*Chemotherapy and other Part B drugs.


$0Drugs on the Medicaid formulary.

Medical equipment and supplies*

$0 (in-network)30% of the cost (out-of-network)Includes oxygen tanks, walkers,

and wheelchairs.

$0Durable medical equipment that

helps alleviate a medical disability or restore or improve bodily function.



13

The Silver&Fit® program is provided by American Specialty Health Fitness, Inc. (ASH Fitness), a subsidiary of American Specialty Health Incorporated (ASH). Silver &Fit is a registered trademark of ASH and used with permission herein.



YOU PAYFitness – Silver&Fit® Healthy

Aging & Exercise Program

Not covered Not covered

Telehealth Services HMSA’s Online Care and other telehealth services

$0 $0

CVS Over the Counter (OTC)Mail Order

$75 quarterly benefit to order over-the-counter health and wellness products available through mail order. You can order items online at cvs.com/otchs/hmsamapd or by phone at 1 (888) 628-2770 (TTY: 711).

$0$75 per quarter Not covered

PRESCRIPTION DRUGS

Prescription Drugs Deductible:$0

If you qualify for a low-income subsidy.

$445 deductible If you don’t qualify

for a low-income subsidy. Initial coverage stage:

Generic drugs, including brand drugs treated as generic

• $0 • $1.30 • $3.70 • 15%

$0Drugs on the Medicaid formulary.

For drugs in the Medicare and HMSA QUEST Integration

formularies: The drug will be processed under the Medicare

formulary and the copayment may be paid by HMSA QUEST Integration

http://cvs.com/otchs/hmsamapd

http://cvs.com/otchs/hmsamapd

14

HMSA Akamai Advantage is a PPO plan with a Medicare contract. Enrollment in HMSA Akamai Advantage depends on contract renewal.

To be enrolled in a Dual Care Special Needs Plan, you must be eligible for your state’s Medicaid program. If you have questions about your Medicaid eligibility and the benefits you’re entitled to, call MedQUEST at 587-3540 on Oahu or 1 (800) 316-8005 toll-free on the Neighbor Islands.

To learn more about the health plan benefits and costs of Original Medicare, see the Medicare & You 2021 Handbook at medicare.gov. To request a copy, call 1 (800) MEDICARE 1 (800) 633-4227 toll-free, 24 hours a day, seven days a week. For TTY, call 1 (877) 486-2048.

HMSA works closely with CVS Caremark (Longs Drugs) to help you get the medications you need. However, other pharmacies are available in our network.

This plan helps you pay for Part D drugs and Part B drugs, such as chemotherapy and some drugs administered by your provider. See the complete list of Part D prescription drugs and any restrictions at hmsa.com/advantage. Cost sharing may differ for long-term care pharmacies.

Out-of-network/non-contracted providers are under no obligation to treat HMSA Akamai Advantage members except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

PRESCRIPTION DRUGS (continued)

Prescription Drugs All other drugs:• $0 • $4.00 • $9.20 • 15%

Until your yearly out-of-pocket drug costs reach $6,550Catastrophic coverage:

$0 After your yearly out-of-pocket

drug costs reach $6,550

http://medicare.gov

http://hmsa.com/advantage

15

Get affordable prescription drugs at convenient locations. We coordinate your prescription costs with Medicare and Medicaid.

Save time with mail order

Your medications will be conveniently mailed to your home. And you can order a constant supply without interruption to help manage chronic conditions.

Affordable generic medications

Our prescription drug list includes generics to help you get the medicines you need at an affordable price. Generics are just as safe and effective as brand-name drugs, but they cost less because they don’t have the same marketing and research costs. You’ll get the same medication for a lower price.

Local pharmacies

Most major retail pharmacy chains and many independent pharmacies in Hawaii participate with HMSA, so you’re sure to find one near you. Find pharmacies at hmsa.com/advantage. Or call us at a number on the back of this brochure so we can help you.

Pharmacy consultations

If you have questions about your prescription medications, talk to pharmacists on the phone or in person. They’ll discuss your prescriptions with you, make sure you understand how to take them, and see if they work well with over-the-counter drugs and supplements you may be taking. To learn more, call CVS Caremark® at 1 (855) 479-3659 toll-free, 24 hours a day, seven days a week. For TTY, call 711.

While traveling

If you need a prescription while you’re on the Mainland, just show your HMSA membership card at one of more than 9,800 CVS pharmacy locations nationwide. You can easily find pharmacies on hmsa.com.

Medications

To see a list of prescription medications covered under your health plan, go to hmsa.com/advantage. Look under Prescription Drugs List (Formulary).

CVS Caremark® is an independent company providing pharmacy benefit management services on behalf of HMSA.


http://hmsa.com


16

Prescription drugs can be mailed to your home from the HMSA Medicare Advantage mail-order pharmacy. Mail-order prescriptions are usually delivered within 14 days after the pharmacy receives the order.

If your drugs don’t arrive within 14 days, please call 1 (855) 479-3659 toll-free, 24 hours a day, seven days a week; TTY users, call 711. Call these numbers if you want to sign up for our optional automatic delivery program.

Extra Help, also known as Low-Income Subsidy, is a federal program that can help you pay for your monthly plan premium and prescription medications. It could lower your premium by up to $25 a month, and lower your medication copayments and coinsurance. Many people qualify and don’t even know it. Visit hmsa.com/advantage to learn more. To find out if you qualify:

• Apply for Extra Help You can apply anytime at socialsecurity.gov/medicare/prescriptionhelp.

• Social Security Administration: 1 (800) 772-1213 toll-free, Monday through Friday, 7 a.m. to 7 p.m. For TTY, call 1 (800) 325-0778 toll-free.

• The state Medicaid office: 1 (800) 316-8005 toll-free.

See if you qualify for Extra Help.

Need help paying for your medications?


http://socialsecurity.gov/medicare/prescriptionhelp

17

Choose one of five easy ways to enroll.

Online Enroll 24/7 at hmsa.com/advantage. Once you submit your application, you’ll receive an application receipt number.

Phone Oahu: 948-6235

• Neighbor Islands: 1 (800) 693-4672 toll-free• TTY: 711

Call 8 a.m. to 8 p.m.Oct. 1 – March 31: Seven days a week.April 1 – Sept. 30: Monday–Friday.

In person We’ll be happy to help you enroll. Visit your nearest HMSA Center. See back page for locations and hours. Before you visit, call us or go to hmsa.com/contact for in-person safety guidelines.

If you’re enrolling in HMSA Medicare Advantage for the first time, we can come to your home or the location of your choice. To make an appointment, call 948-5535, Monday through Friday, 8 a.m. to 4 p.m.

Mail Fill out the HMSA Akamai Advantage application and mail it to:

HMSA Akamai Advantage SalesP.O. Box 3500Honolulu, HI 96811-3500

Through the Medicare Plan Finder Visit medicare.gov.

Enrollment Sign up today!


http://hmsa.com/contact

http://medicare.gov

18

Step 1. You’ll get a care coordinator.

One of the unique features of this plan is the personalized attention you get beyond the doctor’s office. We’ll assign a care coordinator to you who’ll evaluate your health and help you identify and overcome health issues.

Step 2. Take a health questionnaire.

To better serve your health care needs, we need a complete picture of your health and well-being. So before we can start your health plan, we’ll need to ask you some simple questions.

Choose a way to take the questionnaire that’s convenient for you:

• Over the phone.• In person with your care coordinator. • By mail.

Whatever method you choose, the questionnaire will take about 20 to 30 minutes to complete.

Step 3. Meet your care coordinator.

You’ll meet your care coordinator to go over the results of the questionnaire and develop an action plan for areas in your life that you need to improve or maintain. Your care coordinator will work with you and your health care team to get you the care you need.

Step 4. Follow-up care.

Your care coordinator will work with you throughout the year either on the phone or in person to make sure you’re following your action plan and staying on track toward your goals. You can contact your care coordinator any time if you have questions. It’s like having a friend to help you focus on your health.

Here are some things you’ll need to know when you enroll in HMSA Akamai Advantage Dual Care.

Care coordination We’re with you every step of the way

19

Understanding Important Rules

In addition to your monthly plan premium, you must continue to pay your Medicare Part B premium. This premium is normally taken out of your Social Security check each month.

Benefits, premiums, and/or copayments and coinsurance may change on Jan. 1, 2022.

Our plan allows you to see providers outside of our network (non-contracted providers). However, while we’ll pay for covered services provided by a noncontracted provider, the provider must agree to treat you. Except in an emergency or urgent situations, non-contracted providers may deny care. In addition, you will pay a higher copayment for services received by noncontracted providers.

This plan is a dual eligible special needs plan (D-SNP). Your ability to enroll will be based on verification that you are entitled to both Medicare and medical assistance from a state plan under Medicaid.

Understanding the Benefits

Review the full list of benefits found in the Evidence of Coverage, especially for those services for which you routinely see a doctor. Visit hmsa.com/advantage or call us at the numbers listed above.

Review the Provider Directory (or ask your doctor) to make sure the doctors you see now are in the network. If they’re not listed, you’ll likely have to select a new doctor.

Review the Provider Directory to make sure the pharmacy you use for prescription medicine is in the network. If the pharmacy isn’t listed, you’ll likely have to select a new pharmacy for your prescriptions.

Before making an enrollment decision, it is important that you fully understand our benefits and rules.

If you have any questions, you can call and speak to a customer service representative at 948-6235 on Oahu or 1 (800) 693-4672 toll-free. For TTY, call 711.

Pre-enrollment checklist



20

Federal law requires HMSA to provide you with this notice.HMSA complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. HMSA does not exclude people or treat them differently because of things like race, color, national origin, age, disability, or sex.

Services that HMSA providesProvides aids and services to people with disabilities to communicate effectively with us, such as:• Qualified sign language interpreters• Written information in other formats

(large print, audio, accessible electronic formats, other formats)

Provides language services to people whose primary language is not English, such as:• Qualified interpreters• Information written in other languages

If you need these services, please call 1 (800) 776-4672 toll-free; TTY 711

How to file a discrimination-related grievance or complaintIf you believe that we’ve failed to provide these services or discriminated against you in some way, you can file a grievance in any of the following ways:• Phone: 1 (800) 776-4672 toll-free• TTY: 711• Email: [email protected]• Fax: (808) 948-6414 on Oahu• Mail: 818 Keeaumoku St.,

Honolulu, HI 96814

You can also file a civil rights complaint with the U.S. Department of Health and Human Services, Office for Civil Rights, in any of the following ways:• Online:

ocrportal.hhs.gov/ocr/portal/lobby.jsf• Phone: 1 (800) 368-1019 toll-free;

TDD users, call 1 (800) 537-7697 toll-free

• Mail: U.S. Department of Health and Human Services, 200 Independence Ave. S.W., Room 509F, HHH Building, Washington, DC 20201

For complaint forms, please go to hhs.gov/ocr/office/file/index.html.

Hawaiian: E NĀNĀ MAI: Inā hoʻopuka ʻoe i ka ʻŌlelo Hawaiʻi, loaʻa ke kōkua manuahi iā ʻoe. E kelepona iā 1 (800) 776-4672. TTY 711.

Bisaya: ATENSYON: Kung nagsulti ka og Cebuano, aduna kay magamit nga mga serbisyo sa tabang sa lengguwahe, nga walay bayad. Tawag sa 1 (800) 776-4672 nga walay toll. TTY 711.

Chinese: 注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電 1 (800) 776-4672。 TTY 711。

Ilocano: PAKDAAR: Nu saritaem ti Ilocano, ti serbisyo para ti baddang ti lengguahe nga awanan bayadna, ket sidadaan para kenyam. Awagan ti 1 (800) 776-4672 toll-free. TTY 711.

Japanese: 注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。1 (800) 776-4672 をご利用ください。TTY 711。まで、お電話にてご連絡ください。

Korean: 주의: 한국어를사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다. 1 (800) 776-4672번으로 연락해 주시기 바랍 니다. TTY 711 번으로 전화해 주십시오.

Laotian: ກະລຸຸນາສັັງເກດ: ຖ້້າທ່່ານເວົ້້ ້ າພາສັາລຸາວົ້, ການຊ່່ວົ້ຍເຫືຼື� ອດ້ານພາສັາ, ບໍ່່່ ມີີ ຄ່່າໃຊ້່ຈ່່າຍ, ແມ່ີນມີີ ໃຫ້ຼືທ່່ານ. ໂທ່

1 (800) 776-4672 ຟຣີີ . TTY 711.

Marshallese: LALE: Ñe kwōj kōnono Kajin Ṃajōḷ, kwomaroñ bōk jerbal in jipañ ilo kajin ṇe aṃ ejjeḷọk wōṇāān. Kaalọk 1 (800) 776-4672 tollfree, enaj ejjelok wonaan. TTY 711.

Pohnpeian: Ma ke kin lokaian Pohnpei, ke kak ale sawas in sohte pweine. Kahlda nempe wet 1 (800) 776-4672. Me sohte kak rong call TTY 711.

Samoan: MO LOU SILAFIA: Afai e te tautala Gagana fa’a Sāmoa, o loo iai auaunaga fesoasoan, e fai fua e leai se totogi, mo oe, Telefoni mai: 1 (800) 776-4672 e leai se totogi o lenei ‘au’aunaga. TTY 711.

Spanish: ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1 (800) 776-4672. TTY 711.

Tagalog: PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa wika nang walang bayad. Tumawag sa 1 (800) 776-4672 toll-free. TTY 711.

Tongan: FAKATOKANGA’I: Kapau ‘oku ke Lea-Fakatonga, ko e kau tokoni fakatonu lea ‘oku nau fai atu ha tokoni ta’etotongi, pea teke lava ‘o ma’u ia. Telefoni mai 1 (800) 776-4672. TTY 711.

Trukese: MEI AUCHEA: Ika iei foosun fonuomw: Foosun Chuuk, iwe en mei tongeni omw kopwe angei aninisin chiakku, ese kamo. Kori 1 (800) 776-4672, ese kamo. TTY 711.

Vietnamese: CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số 1 (800) 776-4672. TTY 711.

We’re Here to Help You

Call us • Oahu: 948-6235

• Neighbor Islands: 1 (800) 693-4672 toll-free

• TTY: 711

Visit usHMSA Center @ Honolulu

818 Keeaumoku St. Monday–Friday, 8 a.m.–5 p.m. Saturday, 9 a.m.–2 p.m.

HMSA Center @ Pearl City

Pearl City Gateway 1132 Kuala St., Suite 400 Monday–Friday, 9 a.m.–6 p.m. Saturday, 9 a.m.–2 p.m.

HMSA Center @ Kahului

Puunene Shopping Center 70 Hookele St., Suite 1220 Monday–Friday, 9 a.m.–6 p.m. Saturday, 9 a.m.–2 p.m.

8 a.m.–8 p.m.Oct. 1–March 31: Seven days a week.April 1–Sept. 30: Monday–Friday.

HMSA Center @ Hilo

Waiakea Center 303A E. Makaala St. Monday–Friday, 9 a.m.–6 p.m. Saturday, 9 a.m.–2 p.m.

Neighbor Island Offices

Monday–Friday, 8 a.m.–4 p.m.

Kailua-Kona

75-1029 Henry St., Suite 301

Lihue

4366 Kukui Grove St., Suite 103

HAWAI‘I MEDICAL SERVICE ASSOCIATIONhmsa.com/advantage

hmsa.com myhmsa @askHMSA askhmsa

(03) 2025-247756 8:20 JR


http://hmsa.com

Documents

2021 Summary of Benefits · 2021. 1. 15. · PET scans. • Therapeutic radiology services such as radiation treatment for cancer. $0 • Medically necessary diagnostic or therapeutic