Benefits & Coverage

Insurance Type
Individual Health Insurance (Obamacare)
Insurance Provider
HMSA
Metal Level
Gold
Plan Type
HMO
Deductible
$1000
Out-of-Pocket Maximum
$4000
Plan Highlights

Cost & Coverage

Estimated Monthly Base Rate
Estimated monthly premium starts at $487.20
Deductible
Individual: $1000
Family: $2000
In-Network Out-of-Pocket Limit
Individual: $4000
Family: $8000
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
HMO

Health Services Options

Service
In Network
Out of Network
Primary care physician office visit
$25 Copay after deductible
Not Covered
Specialist
$25 Copay after deductible
Not Covered
Diagnostic Test (X-ray, blood work)
10% Coinsurance after deductible
Not Covered
Outpatient Facility Fee
10% Coinsurance after deductible
Not Covered
Outpatient Physician/Surgeon Fee
10% Coinsurance after deductible
Not Covered
Hospital facility fee
10% Coinsurance after deductible
Not Covered
Hospital physician/surgeon fee
10% Coinsurance after deductible
Not Covered
Emergency Room
20% Coinsurance after deductible
20% Coinsurance after deductible

Drug Services

Generic Drugs
Coverage: $7 Copay before deductible
Preferred Brand Drugs
Coverage: $30 Copay after deductible
Specialty Drugs
Coverage: $100 Copay after deductible

Mental Health or Substance Abuse Services

Service
In Network
Out of Network
Mental/behavioral health outpatient services
10% Coinsurance after deductible
Not Covered
Mental/behavioral health inpatient services
10% Coinsurance after deductible
Not Covered
Substance use disorder inpatient services
10% Coinsurance after deductible
Not Covered
Substance use disorder outpatient services
10% Coinsurance after deductible
Not Covered

Maternity Services

Service
In Network
Out of Network
Prenatal/postnatal care
$25 Copay after deductible
Not Covered
Delivery and all inpatient services for maternity care
10% Coinsurance after deductible
Not Covered

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-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
  • Non-emergency care outside U.S.
  • 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 available on healthcare.gov or other Health Exchanges

Physician Directory

List of doctors that accepts HMSA Gold HMO 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
TINHAN, ERIK
98-1247 KAAHUMANU ST
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
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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