HMSA Bronze PPO 6350

Individual Health Insurance (Obamacare)

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Benefits & Coverage

Plan Name
HMSA Bronze PPO 6350
Plan ID
18350HI0880033
Plan Year
2014
Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
HMSA
Metal Level
Bronze
Plan Type
PPO
Deductible
$6,350
Out-of-Pocket Maximum
$6,350
Plan Highlights

Cost & Coverage

Estimated Monthly Base Rate
Estimated monthly premium starts at $255.81
Deductible
Individual: $6350
Family: $12700
In-Network Out-of-Pocket Limit
Individual: $6350
Family: $12700
What is included in the in-network out-of-pocket limit?
Deductible + Coinsurance + Co-pay
Is this plan Health Savings Account (HSA) eligible?
No
How can I find a doctor in this plan's network?
Plan Type
PPO

Health Services Options

Service
In Network
Out of Network
Primary care physician office visit
No Charge after deductible
No Charge after deductible
Specialist
No Charge after deductible
No Charge after deductible
Diagnostic Test (X-ray, blood work)
No Charge after deductible
No Charge after deductible
Outpatient Facility Fee
No Charge after deductible
No Charge after deductible
Outpatient Physician/Surgeon Fee
No Charge after deductible
No Charge after deductible
Hospital facility fee
No Charge after deductible
No Charge after deductible
Hospital physician/surgeon fee
No Charge after deductible
No Charge after deductible
Emergency Room
No Charge after deductible
No Charge after deductible

Drug Services

Generic Drugs
Coverage: $7 Copay before deductible
Preferred Brand Drugs
Coverage: No Charge after deductible
Specialty Drugs
Coverage: No Charge after deductible

Mental Health or Substance Abuse Services

Service
In Network
Out of Network
Mental/behavioral health outpatient services
No Charge after deductible
No Charge after deductible
Mental/behavioral health inpatient services
No Charge after deductible
No Charge after deductible
Substance use disorder inpatient services
No Charge after deductible
No Charge after deductible
Substance use disorder outpatient services
No Charge after deductible
No Charge after deductible

Maternity Services

Service
In Network
Out of Network
Prenatal/postnatal care
No Charge after deductible
No Charge after deductible
Delivery and all inpatient services for maternity care
No Charge after deductible
No Charge after deductible

Coverage Options Summary

Included Benefits
  • Bariatric surgery
  • Dental care adult
  • Durable medical equipment
  • Emergency Transportation
  • Eye glasses children
  • Habilitation
  • Home health care
  • Hospice
  • Imaging (CT/PET scans, MRIs)
  • Inpatient rehabilitation
  • Non-emergency care outside U.S.
  • Non-preferred brand drugs
  • Skilled nursing care
  • Other practitioner office visit
  • Outpatient rehabilitation
  • Preventive care, screening, immunization
  • Routine eye exam children
  • Routine hearing tests
  • Urgent Care
Excluded Benefits
  • Acupuncture
  • Chiropractic
  • Cosmetic surgery
  • Dental check up children
  • Long Term Care
  • Private duty nursing
  • Routine foot care
  • Weight loss program
Limited Benefits
  • Eye exam adult
  • Hearing Aid
  • Infertility treatment

What To Know

  • This is an ACA (Obamacare) compliant health plan.
  • This plan is not eligible for a tax credit subsidy

Physician Directory

List of doctors that accepts HMSA Bronze PPO 6350 Obamacare Plan in Hawaii

/
COLE, JASMIN
755 SCOTT CIR
HICKAM AFB, HI 96853
KOBAYASHI, LLOYD
98-1079 MOANALUA RD
AIEA, HI 96701
HENRY, THOMAS
98-084 KAMEHAMEHA HWY
AIEA, HI 96701
IZUKA, BYRON
98-1079 MOANALUA RD
AIEA, HI 96701
MIYASATO, STEPHEN
99-128 AIEA HTS DR
AIEA, HI 96701
HEALY, JEFF
98-1079 MOANALUA ROAD
AIEA, HI 96701
HAMASAKI, CRAIG
98-1247 KAAHUMANU STREET
AIEA, HI 96701
ALLISON, JERRY
13330 NOEL RD
DALLAS, TX 75240
TAKIGUCHI, PAUL
98-1079 MOANALUA RD
AIEA, HI 96701
FROE, FELECIA
98-151 PALI MOMI ST
AIEA, HI 96701
OISHI, CALVIN
98-1079 MOANALUA RD
AIEA, HI 96701
LEE, DARRELL
98-211 PALI MOMI ST
AIEA, HI 96701
OKI, ALAN
98-1079 MOANALUA RD
AIEA, HI 96701
WILSON, CHARLES
91-2139 FORT WEAVER RD
EWA BEACH, HI 96706
OGAWA, ROBERT
99-128 AIEA HEIGHTS DR
AIEA, HI 96701
HANAGAMI, RONALD
99-862 AIEA HEIGHTS DR
AIEA, HI 96701
CHINGON, HARRY
98-211 PALI MOMI ST
AIEA, HI 96701
POPPER, JORDAN
320 WARD AVE STE 101
HONOLULU, HI 96814
OGAWA, RUSSELL
99-128 AIEA HEIGHTS DR
AIEA, HI 96701
ROVNER, BRIDGIT
98-1079 MOANALUA ROAD
AIEA, HI 96701
MIHARA, MICHAEL
98-1079 MOANALUA ROAD
AIEA, HI 96701
TANABE, FRED
98-1079 MOANALUA ROAD
AIEA, HI 96701
MASUDA, ALAN
98-1079 MOANALUA ROAD
AIEA, HI 96701
CHAN, PAUL
98-1079 MOANALUA ROAD
AIEA, HI 96701
MATSUMOTO, BRYAN
98-1079 MOANALUA ROAD
AIEA, HI 96701
Details
JASMIN COLE, M.D.
Phone Number
(808) 448-6100
Office Locations
755 SCOTT CIR
HICKAM AFB, HI 96853
755 SCOTT CIR HICKAM AFB HI, 96853

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