Hawaii Benefit Plans
| MEDICAL BENEFITS | KAISER HAWAII GOLD BE FIT | HMSA COMPMED |
|---|---|---|
| Deductible In-Network Out-of-Network | $200/$400 OON N/A- only in-network benefits | None None |
| Out-Of-Pocket Maximum In-Network Out-of-Network | Includes deductible, coinsurance and copays $2,200/$4,400 N/A | Includes coinsurance and copays $2,500/$7,500 $2,500/$7,500 |
| Coinsurance In-Network Out-of-Network | You pay 10% after deductible N/A | You pay 20% You pay 20% |
| Lifetime Max | Unlimited | Unlimited |
| Preventive Care In-Network Out-of-Network | No charge N/A | No charge No charge |
| Telehealth/Virtual Visit | You pay $15 copay | HMSA Online Care: You pay $0 copay Other telehealth services: You pay $14 copay |
| Physician Office Visit In-Network Out-of-Network | You pay $15 copay N/A | You pay $14 copay You pay $14 copay |
| Specialist Office Visit In-Network Out-of-Network | You pay $15 copay N/A | You pay $14 copay You pay $14 copay |
| Basic Lab & Radiology In-Network Out-of-Network | You pay $20 copay N/A | You pay 20% coinsurance You pay 20% coinsurance |
| Emergency Room In-Network Out-of-Network | You pay 20% coinsurance, deductible does not apply N/A | You pay $20 copay plus 20% You pay $20 copay plus 20% |
| Urgent Care In-Network Out-of-Network | You pay $15 copay You pay 20% coinsurance, deductible does not apply | You pay $14 copay You pay $14 copay |
| Major Lab & Radiology (MRI/CT/PET) In-Network Out-of-Network | Prior Authorization Required You pay 20% coinsurance after deductible N/A | Prior Authorization Required You pay 20% coinsurance You pay 20% coinsurance |
| Inpatient Hospital In-Network Out-of-Network | You pay 10% coinsurance after deductible N/A | You pay 20% coinsurance You pay 20% coinsurance |
| Outpatient Surgery In-Network Out-of-Network | You pay 10% coinsurance after deductible N/A | You pay 20% coinsurance You pay 20% coinsurance |
| Prescriptions | ||
| Annual Out-of-Pocket Maximum | N/A | $3,600 individual/$4,200 family (both in and out of network) |
| In-Network Retail (up to 30 day supply) | Other Generics: You pay $20 copay Brand: You pay 50% Specialty: You pay 50% (after $250 individual/$500 family deductible for specialty drugs) | Generic: You pay $7 copay Preferred Brand: You pay $30 copay Non-Preferred Brand: You pay $30 copay plus $45 for other brand-name cost sharing Preferred Specialty: You pay $100 copay Non-Preferred Specialty: You pay $200 copay Specialty: Not covered |
| In-Network Mail Order (up to 90 day supply) | Generic Maintenance: You pay $20 copay Other Generics: You pay $40 copay Brand: You pay 50% Specialty: You pay 50% (after $250 individual/$500 family deductible for specialty drugs) | Generic: You pay $11 copay Preferred Brand: You pay $65 copay Non-Preferred Brand: You pay $65 copay plus $135 for other brand-name cost sharing Specialty: Not covered |
| Plan | When You Become Eligible | Your Eligible Dependents | When You Enroll | Benefits Effective Date |
| Kaiser & HMSA* | After you've worked at least 20 hours per week for 4 consecutive weeks | • Spouse or domestic partner (where applicable) • Children (where applicable) | • Within 30 days of becoming eligible | • The first of the month after you become eligible |
| • During 2024 Open Enrollment (if eligible) | • January 1, 2024 | |||
| Group Hospital Indemnity Plans, Dental, Vision, Life and AD&D, Critical Illness & Accident Insurance | When you receive your first Robert Half pay statement | • Spouse or domestic partner (where applicable) • Children (where applicable) | • Within 30 days of becoming eligible | • On the Monday of the week in which a deduction is taken from your paycheck |
| • During 2024 Open Enrollment (if eligible) | • January 1, 2024 |
*When you become eligible for the Kaiser or HMSA plan and do not take action, you will be automatically enrolled in the Kaiser employee-only plan. In accordance with the provisions of the Hawaii Prepaid Care Act, you must download and complete the HC-5 Waiver form if you do not want to enroll in a Hawaii medical plan. The effective date of coverage will be the first of the month following the date you attain eligibility. Your share of the premium cost will be deducted from your paychecks.
Coverage Termination & Continuation
In order to remain eligible for medical coverage, you must continue to work at least 20 hours per week. If you have four consecutive weeks working less than 20 hours each week, your coverage will end on the last day of that month.
Contacts
| CARRIER(S) | CARRIER CONTACT(S) |
| Kaiser Permanente | 1.877.580.6125 kp.org |
| HMSA | 1.808.948.6111 hmsa.com |
| The American Worker | 1.855.495.1192 RHAWPbenefits.com |
