AHH, HAWAII Medical Coverage Hawaii employees have a choice of three plans, from HMSA (also known as Blue Cross/Blue Shield of Hawaii) and Kaiser. While one is a traditional PPO plan and the others are HMOs, they’re a lot alike. All feature no cost for preventive care, generally low out-of-pocket costs. The main difference is that in the PPO you can see providers outside the network, generally at a higher cost. HMSA PPO HMSA HMO Kaiser HMO In-network Out-of-network In-network In-network Annual deductible $350 per employee $350 per employee $350 employee None $1,050 per family $1,050 per family $1,050 family Out-of-pocket $3,000 employee $3,000 employee $3,000 employee $2,500 employee maximum $9,000 family $9,000 family $9,000 family $7,500 family Physician visit $17 after deductible $17 after deductible $20 $15 Well-baby care Free Free Free Free Preventive care Free Free Free Free Hospital, inpatient 20% coinsurance after 20% coinsurance after 20% after deductible 20% coinsurance deductible deductible Outpatient surgery 20% coinsurance after 20% coinsurance after 20% after deductible 20% coinsurance facility fee deductible deductible $17 physician visit; 10% $17 physician visit; 10% $20 physician visit; Outpatient surgery coinsurance (cutting); 20% coinsurance (cutting); 20% $20 (cutting); $20 (non- 20% coinsurance surgeon fee coinsurance (non-cutting) after coinsurance (non-cutting) after cutting) deductible deductible Emergency room 20% coinsurance after 20% after deductible 20% after deductible 20% deductible Prescriptions, generic $7 $7 copay plus 20% coinsurance $7 $10 per prescription Prescriptions, mostly $30 $30 copay plus 20% $30 $45 preferred brand coinsurance per prescription $30 copay plus 20% Prescriptions, mostly $30 copay plus coinsurance per prescription $30 copay plus $45 non-preferred brand $45 cost share plus $45 other brand name cost $45 cost share share Mostly preferred $100 Not Covered $100 $200 specialty drugs Mostly non-preferred $200 Not Covered $200 $200 specialty drugs Prescriptions, $3,600 employee $3,600 employee $3,600 employee None out-of-pocket maximum $4,200 family $4,200 family $4,200 family