The Hawaii Medical Service Association (HMSA) Thursday announced a new low-cost health plan for individuals not covered by a group plan.
The HMSA Catastrophic Care Plan is an alternative to more expensive comprehensive coverage, and it goes into effect April 1.
It allows members to save money on monthly dues and preventive care, while providing key benefits in case of a serious illness, injury or hospitalization.
Monthly dues for the new plan are as follows: $97.25 for single coverage, $194.50 for two-party coverage, and $291.75 for family coverage.
The HMSA Catastrophic Care Plan features an annual deductible of $2,000 per person, up to a maximum of $4,000 for a family of two or more.
Once the deductible is met, the plan pays 80 percent of HMSA’s eligible charges for most services when using a participating provider.
For services such as physician visits, ambulance service, emergency room visits and diabetic supplies, the member pays a predictable, fixed dollar copayment.
Another feature of the Catastrophic Care Plan is coverage for some important preventive services. Preventive services are not subject to the annual deductible.
They apply immediately and are covered at 100 percent when using HMSA participating providers.
Preventive services include well-child care, well-woman exams, mammography screening, routine Pap smears, prostate specific antigen (PSA) test, glucose test, cholesterol test and fecal occult blood tests.
Another level of financial protection for members is the annual maximum copayment feature.
The plan’s annual maximum copayment is $3,000 for single coverage and $6,000 for family coverage. Once the annual maximum copayment and deductible are met, the plan pays 100 percent of eligible charges for covered services, up to a lifetime maximum amount of $5 million.
“At the present time, a day in the hospital in a semi-private room can cost as much as $3,400,” said Cliff Cisco, senior vice president of HMSA. “An MRI brain scan can cost up to $2,000. So when you consider the costs associated with a very serious injury or illness, you begin to understand the value of our new Catastrophic Care Plan.”
Cisco added that if a member ever meets the lifetime maximum of $5 million, the plan continues to pay $10,000 per year as long as the member maintains coverage.
Members have the freedom to choose any health care provider in the state. However, they receive the best value from their coverage when selecting from among the 2,000 HMSA participating providers.
These providers have agreements with HMSA to charge members no more than HMSA’s eligible charge.
The Catastrophic Care Plan also features no claim forms to file when using participating providers, nationwide coverage through the BlueCard PPO network when traveling away from home, health risk assessment and preventive services through HealthPass, and predictable copayments of $20 for participating physician office visits once the annual deductible is met.
Eligible members may also participate in HMSA disease management programs at no cost.
These programs are for members with asthma, diabetes, high-risk pregnancies, cardiovascular disease and behavioral health conditions (mental health and substance abuse).
Members may also take advantage of an array of free value-added classes designed to help them maintain their good health. Classes include Body Power, Stress Master, Positively Pregnant, and more.
