If you live in Hawaii, you may choose from two Medical Plan options: Hawaii Medical Service Association (HMSA) or Kaiser Hawaii HMO. You may not enroll in the national Medical Plan options through Cigna or UnitedHealthcare. Coverage eligibility is based on your home ZIP code.
What’s new for the HMSA option in 2016:
- Autism spectrum disorders: The plan as mandated by state law will provide coverage for the diagnosis and treatment of autism spectrum disorders, including Applied Behavioral Analysis (ABA) Therapy. Contact HMSA for further details regarding coverage.
- New benefits as required by state law: All of HMSA health plans will include state-mandated benefits, such as medically necessary orthodontic services for treatment of orofacial anomalies due to birth defects and coverage for the diagnosis and treatment of autism.
- IRS tax form: For 2016, you will receive an IRS form called the Affordable Care Act (ACA) 1095 Form. This form shows the months of the year that you and/or your dependents were offered or enrolled in medical coverage in 2016. This form will not replace any state forms you may receive providing proof of medical insurance. This form will be in addition to your 2016 IRS Form W2. You will receive the form by January 31, 2017.
See the Hawaii Medical plan design chart.
What’s new for the Kaiser Hawaii option in 2016:
- No day limit for visiting members: Visiting members seeking care at Kaiser Permanente facilities outside their home region no longer have a 90-day limit on the coverage for those services.
- In vitro fertilization update: In vitro fertilization is now covered for unmarried women and for women using a non-spousal sperm donor. All other benefit limitations still apply.
- Benefits covered with a single copay or coinsurance: To simplify paying for care, services provided as part of the hospital, observation, outpatient surgery1, skilled nursing facility, dialysis, radiation therapy and emergency room2 benefits categories are covered under a single copay or coinsurance.
- Specialty drugs: There is a new $75 copay tier option for certain specialty drugs.
- New benefits as required by state law: All of Kaiser 2016 health plans will include state-mandated benefits, such as medically necessary orthodontic services for treatment of orofacial anomalies due to birth defects and coverage for the diagnosis and treatment of autism.
See the Hawaii Medical plan design chart.