HMSA Platinum PPO
HMSA · 2027 plan year
Platinum
- Ind. deductible
- $0
- Family deductible
- $0
- Ind. OOP max
- $5,900
- Family OOP max
- $11,800
Compare with other Platinum plans in HI
Side by side: deductibles, out-of-pocket limits and copays.
Other cost-sharing reduction variants for this plan:
More HMSA plans in HI
Monthly premiums by age
Rating Area 1
| Age | Individual | Individual + tobacco |
|---|---|---|
| Under 15 | $490 | $490 |
| 21 | $641 | $769 |
| 30 | $727 | $873 |
| 40 | $819 | $983 |
| 50 | $1,145 | $1,374 |
| 60 | $1,739 | $2,087 |
| 64 and over | $1,923 | $2,307 |
Live premium estimate
Benefits & cost sharing
Primary Care
| Benefit | In-network |
|---|---|
| Preventive Care/Screening/Immunization | No charge |
| Primary Care Visit to Treat an Injury or Illness | $20.00 |
Specialist
| Benefit | In-network |
|---|---|
| Specialist Visit | $40.00 |
Hospital
| Benefit | In-network |
|---|---|
| Emergency Room Services | $250.00 |
| Inpatient Hospital Services (e.g., Hospital Stay) | $400.00 Copay per Stay |
| Outpatient Surgery Physician/Surgical Services | $250.00 |
| Urgent Care Centers or Facilities | $30.00 |
Pharmacy
| Benefit | In-network |
|---|---|
| Generic Drugs | $10.00 |
| Non-Preferred Brand Drugs | $60.00 |
| Preferred Brand Drugs | $20.00 |
| Specialty Drugs | $250.00 |
Mental Health
| Benefit | In-network |
|---|---|
| Mental/Behavioral Health Inpatient Services | $400.00 Copay per Stay |
| Mental/Behavioral Health Outpatient Services | $20.00 |
Other
| Benefit | In-network |
|---|---|
| Abortion for Which Public Funding is Prohibited | 10.00% |
| Accidental Dental | $250.00 |
| Acupuncture | $20.00 |
| Allergy Testing | 10.00% |
| Applied Behavior Analysis Based Therapies | No charge |
| Autism Spectrum Disorders | No charge |
| Bariatric Surgery | $250.00 |
| Basic Dental Care - Adult | Not covered |
| Basic Dental Care - Child | Not covered |
| Chemotherapy | 10.00% |
| Chiropractic Care | $40.00 |
| Cosmetic Surgery | Not covered |
| Delivery and All Inpatient Services for Maternity Care | $350.00 |
| Dental Check-Up for Children | Not covered |
| Diabetes Education | No charge |
| Dialysis | 10.00% |
| Durable Medical Equipment | 10.00% |
| Emergency Transportation/Ambulance | 10.00% |
| Eye Glasses for Children | No charge |
| Gender Affirming Care | 10.00% |
| Habilitation Services | $20.00 |
| Hearing Aids | 10.00% |
| Home Health Care Services | 10.00% |
| Hospice Services | No charge |
| Imaging (CT/PET Scans, MRIs) | $250.00 |
| Infertility Treatment | $250.00 |
| Infusion Therapy | 10.00% |
| Inpatient Physician and Surgical Services | $250.00 |
| Laboratory Outpatient and Professional Services | $60.00 |
| Long-Term/Custodial Nursing Home Care | Not covered |
| Major Dental Care - Adult | Not covered |
| Major Dental Care - Child | Not covered |
| Nutritional Counseling | No charge |
| Orthodontia - Adult | Not covered |
| Orthodontia - Child | Not covered |
| Orthodontic Services to Treat Orofacial Anomalies | No charge |
| Other Practitioner Office Visit (Nurse, Physician Assistant) | $20.00 |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center) | $250.00 |
| Outpatient Rehabilitation Services | $20.00 |
| Prenatal and Postnatal Care | 10.00% |
| Private-Duty Nursing | Not covered |
| Prosthetic Devices | 10.00% |
| Radiation | 10.00% |
| Reconstructive Surgery | $250.00 |
| Rehabilitative Occupational and Rehabilitative Physical Therapy | $20.00 |
| Rehabilitative Speech Therapy | $20.00 |
| Routine Dental Services (Adult) | Not covered |
| Routine Eye Exam (Adult) | $10.00 |
| Routine Eye Exam for Children | No charge |
| Routine Foot Care | Not covered |
| Skilled Nursing Facility | $250.00 Copay per Stay |
| Substance Abuse Disorder Inpatient Services | $400.00 Copay per Stay |
| Substance Abuse Disorder Outpatient Services | $20.00 |
| Telehealth | $20.00 |
| Transplant | No charge |
| Treatment for Temporomandibular Joint Disorders | Not covered |
| Weight Loss Programs | Not covered |
| Well Baby Visits and Care | No charge |
| X-rays and Diagnostic Imaging | $60.00 |
Plan rules
Service area
This plan covers 1 geographic area.
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