1. Open Enrollment For Gemini – North Employee Benefits
January 1, 2017 through December 31, 2017

2. Agenda Benefits Package Open Enrollment & Qualifying Events
Medical Plan
Dental Plan
Other Benefits
Taking Action

3. Benefits Package Employer Provided Elections Life Insurance
Accidental Death & Dismemberment Insurance
Hawaii TDI
Supplemental Short Term Disability
Long-Term Disability
Travel Accident
Medical Benefits Abroad
401(a) Contributions
Medical Plan
Dental Plan
Flexible Spending Account
Voluntary Life Insurance
Dependent Life Insurance
Voluntary Accidental Death & Dismemberment Insurance
Dependent Accidental Death & Dismemberment Insurance
403 (b) and 457 (b) Contributions

4. Open Enrollment Open Enrollment is Your Opportunity to:
Add or delete dependents
Change coverage
Waiver coverage
Participate in a Flexible Spending Account
2016 Elections will continue for 2017 except for FSA contributions which must be re-elected
Changes are effective January 1, 2017 through December 31, 2017

5. Qualifying Events
Changes during the plan year are allowed only if you have a qualified status change / Qualifying Event such as:
Marriage, Legal Separation, and Divorce
Birth or Adoption of a Child
Dependent Child meeting Maximum Age Limits
Eligibility of Medicare or AHCCCS
Change in employment for you or your spouse that affects coverage (termination of employment, part-time to full-time, etc.)

6. Qualifying Events
You must report a Qualifying Event to HR within 30 days!
You are responsible for informing Benefit Services within 30 days of a marriage, final divorce decree, birth of a child, children over age 26.
If You do not notify HR within 30 days, you will lose your right to make a mid year change:
You will have to wait until next year’s Open Enrollment to make your change
COBRA Rights could be lost

7. Information Sources Informed Healthcare Consumer
Open Enrollment Materials
Benefits Guide
Summary of Benefits and Coverage (SBC) for each medical plan as required by Healthcare Reform
Open Enrollment Website
Log-In for Open Enrollment materials, summaries of benefits, etc.
HMSA – Login to
Kaiser – Login to
UltiPro – Enroll and look up your current benefit elections

8. View Current Benefits 2) Hover over “Myself”
1) Go to:
Enter: username & password
2) Hover over “Myself”
3) Select “Current Benefits” from the list.

9. Add / Change Benefits 2) Hover over “Myself”
1) Go to:
Enter: username & password
2) Hover over “Myself”
3) Select “Open Enrollment”
4) Select Link to access your Open Enrollment Session
TIP: These resources are available for you to review for detailed session navigation, including making your elections.

10. Special Enrollment Notes
Tips for a seamless enrollment experience:
Use Internet Explorer (IE) 11.0 for the best Ultipro Experience. For an Ultipro Browser Compatibility Guide, visit
Make sure to read ALL messaging in the session for important information and instructions
Only enter the session if you want to make changes, you can view your election under the benefits summary
Scroll through the entire page for all benefit plan options.
Benefit end date for current benefits is 12/31/2016. New benefit elections will begin effective 01/01/2017.
Dependent SSN, Date of Birth, and Gender are required fields in order to add dependents to a plan. If your dependent does not have a US SSN, please enter all 9’s in this field (999*99*9999 )

11. 2017 Contributions TOTAL MONTHLY EMPLOYER PREMIUM EMPLOYEE PREMIUM
Semi-Monthly
MEDICAL
Health Plan Hawaii (HMO)-HPH B
EE Only
$378.58
$189.29
$0.00
EE + One Dependent
$757.14
$567.86
$283.93
$189.28
$94.64
EE + Family
$1,135.32
$756.95
$378.48
$378.37
$189.19
Preferred Provider Plan (PPO)-PPP B
$349.92
$174.96
$699.82
$524.87
$262.44
$174.95
$87.48
$1,049.34
$699.63
$349.82
$349.71
$174.86
Kaiser HMO
$458.19
$79.61
$39.81
$916.38
$348.52
$174.26
$1,374.58
$617.63
$308.82
Kaiser Added Choice
$649.48
$270.90
$135.45
$1,298.96
$731.10
$365.55
$1,948.38
$1,191.43
$595.72

12. 2017 Contributions TOTAL MONTHLY EMPLOYER PREMIUM EMPLOYEE PREMIUM
Semi-Monthly
DENTAL
L95 Prepaid Plan
EE Only
$36.90
$18.45
$0.00
EE + One Dependent
$73.80
$55.35
$27.68
$9.23
EE + Family
$110.70
D90 Preferred Provider Plan (PPO)

13. Get the Best With HMSA AURA Gemini November 4, 2016
Good morning/Good afternoon/Aloha, my name is _____________ and I’m a health plan adviser at HMSA.
Thank you for this opportunity to be here today and for choosing HMSA. As we continually work to advance the health and well-being of Hawaii’s residents, you can rest assured that you can count on us.
Today, I’ll share some valuable information with you about HMSA and your health plan options.

14. It’s Our Privilege to Serve You
Most experienced plan in Hawaii
Improving the health and well-being of Hawaii
Our strong reserve protects our members
You can always count on us!
Our history
We’re the oldest, most experienced plan in Hawaii.
We’ve had the privilege of serving Hawaii for nearly 80 years.
Social workers dedicated to and passionate about the well-being of Hawaii’s people started HMSA.
Dedicated to the health of Hawaii’s people
We’re striving to improve the health and well-being of all Hawaii.
Financial strength
We’re a nonprofit organization. We put our members’ interests first.
We spend your health care dollars wisely. An average of 90 cents per premium dollar pays for your health care.
We have a strong reserve to protect our members if there’s an emergency.
Here to serve you when you need us
You can always reach us by phone, , in-person, or through social media. Our HMSA Centers and offices are open just for you.

15. Hawaii’s Well-being Leader
HMSA’s Vision
Our vision of a healthier Hawaii is a sustainable health care system where all residents are at the center of, in control of, and responsible for their own well-being. We’ll accomplish this through unrelenting innovation, unprecedented partnerships, and uncompromising consumer focus.
HMSA’s Mission
Our mission is to provide the people of Hawaii access to a sustainable, quality health care system that improves the overall health and well-being of our state.
Our mission is to provide the people of Hawaii access to a sustainable, quality health care system that improves the overall health and well-being of our state.

16. Get More with HMSA Expansive provider network
More access to doctors and the state’s top hospitals
Benefits and services that support your good health and well- being
In short, you simply get more with HMSA.
The freedom to choose from an expansive provider network.
With HMSA, members can choose from thousands doctors and specialists in Hawaii. That means you can see them close to where you live or work.
More access to doctors.
Whether it’s the weekend, holiday, or after traditional office hours, you’re always covered. Members can go to participating urgent care clinics, see a doctor on a smartphone or tablet with HMSA’s Online Care®, or speak to a nurse at CVS/minuteclinic®, the medical clinic in Longs Drugs stores on Oahu.
Care from the top hospitals in the state.
HMSA’s network includes the top hospitals in the state, such as Kapiolani Medical Center for Women & Children, The Queen’s Medical Center, and Straub Clinic & Hospital.
Kapiolani Medical Center for Women & Children is Hawaii’s only full-service women’s and children’s hospital and designated pediatric center.
The Queen’s Medical Center is the main trauma center in the Pacific Basin and the state’s only organ transplant center.
Straub is home to the Pacific region’s only multidisciplinary burn treatment center.
In Hawaii, the Queen’s Medical Center holds Blue Distinction for cardiac care. Pali Momi Medical Center and Castle Medical Center have earned it for bariatric surgery. BCBSA gives this designation to hospitals that are recognized for their expertise and efficiency in delivering quality and cost-effective specialty care.
Benefits that support your good health and well-being.

17. Preventive Services to Keep You Healthy
Immunizations
Mammograms
Well-women exams
Well-child visits
Cancer screenings
And more
All HMSA plans include preventive services such as:
Immunizations.
Mammograms.
Well-women exams.
Well-child visits through age 21.
Cancer screenings.

18. More Access to Hawaii’s Best Hospitals
Care from the top hospitals in the state.
HMSA’s network includes the top hospitals in the state, such as Kapiolani Medical Center for Women & Children, The Queen’s Medical Center, and Straub Clinic & Hospital.
Kapiolani Medical Center for Women & Children is Hawaii’s only full-service women’s and children’s hospital and designated pediatric center.
The Queen’s Medical Center is the main trauma center in the Pacific Basin and the state’s only organ transplant center.
Straub is home to the Pacific region’s only multidisciplinary burn treatment center.
In Hawaii, the Queen’s Medical Center holds Blue Distinction for cardiac care. Pali Momi Medical Center and Castle Medical Center have earned it for bariatric surgery. BCBSA gives  this designation to hospitals that are recognized for their expertise and efficiency in delivering quality and cost-effective specialty care.

19. The Blue Cross and Blue Shield Advantage
Nation’s oldest and largest health plan
Extensive provider network
96% of all hospitals
92% of providers
More than half of all U.S. federal workers, retirees, and their families rely on BCBS
The Blue Cross and Blue Shield Advantage
HMSA is an independent licensee of the Blue Cross and Blue Shield Association
Nation’s oldest and largest (105 million people or one in three Americans rely on Blue Cross and Blue Shield companies)
Nationwide (96 percent hospitals 92 percent providers) and worldwide access
More than half of all U.S. federal workers, retirees, and their families rely on BCBS, making FEP the largest single health plan group in the world

20. Peace of Mind When You Travel
Access to 750,000 BCBS providers in the nation
Nearly 200 countries and territories worldwide
Emergency and urgent care abroad
The BlueCard program provides you with Mainland coverage. You’ll have access to one of the largest provider networks in the nation with 750,000 Blue Cross and Blue Shield providers. Across the U.S., more than 96 percent of hospitals and 92 percent of physicians and other providers contract with Blue Cross and Blue Shield.
If you travel internationally and need medical services, you may need to pay the charge and we’ll reimburse you. To get reimbursed, you need to submit an itemized list of services that includes:
Provider’s name
Address
Telephone number
Date of service
Description of each service
Cost
If you’ll be on the Mainland for at least 90 days, you can take advantage of our Guest Membership program. At no additional cost to you, Guest Membership provides you with full plan benefits of a host HMO in the area you’ll be visiting – not just urgent or emergency care. This includes preventive care, office visits, and any other benefits associated with the host HMO plan. When you return, your current plan benefits continue.
With most HMSA plans, you’re also protected for emergency care services while away from home, both on the Mainland and abroad.
If you find yourself in a life-threatening medical situation, go directly to the nearest emergency room where you’ll receive coverage for $100.
HMSA’s Preferred Provider Plan and CompMED plans help pay for medical care if you’re traveling on the Mainland or abroad. Simply call the number on the back of your HMSA membership card and we’ll provide you with the names of three providers in the area you’ll be traveling in.

21. Strategic Partnerships that Benefit Our Members
Healthways
CVS/caremark
Beacon Health Strategies
Life Specialty Ventures
American Specialty Health
Blue Zones Project
We offer our members a more integrated approach to health care through strategic partnerships that support our members’ total health and well-being.
Over the past 15 years, we’ve worked with well-being solutions provider Healthways to improve the health and well-being of Hawaii. In 2015, Healthways joined HMSA so that we can more effectively deliver well-being tools and resources to our members.
CVS/caremark, our pharmacy benefits manager, has the experience to help manage drug costs for our members.
We work with Beacon Health Strategies to provide behavioral health and substance abuse service management and support for our members.
We identify and manage any gaps in our members’ care by looking at medical and dental information. LSV and USAble Life, through their affiliate, LSV Dental Management, LLC serve as administrator for HMSA’s dental plans.
We also work with American Specialty Health to offer additional services that our members value. Your employer can add these services to your medical plan.
Supporting a healthier and happier Hawaii is our priority.
In 2014, we launched the Blue Zones Project in Hawaii to start a well-being revolution in our workplaces, schools, restaurants, grocery stores, and communities statewide.

22. Health Plans That Work for You
PPO Preferred Provider Plan
HMO Health Plan Hawaii
HMSA gives you the freedom to choose the plan that’s best for you.
Preferred Provider Plan – our free-choice plan, featuring a large network of participating providers.
CompMED – short for comprehensive medical, this is also a free-choice plan with a large provider network.
Health Plan Hawaii Plus – a top-quality health maintenance organization plan featuring access to one of the state’s largest HMO provider network.
All HMSA plans offer you value and peace of mind with an extensive local provider network, access to the state’s top hospitals, coverage when you travel, and representatives to answer your questions in person or over the phone. Today, we’ll talk more about these plan options.
No matter which plan you select, you’ll have peace of mind with an annual out-of-pocket limit of $2,500 per person and $7,500 per family. This financial protection is there for you in case of catastrophic illness or injury. Once you reach the limit, HMSA will pay 100 percent of the eligible charges through the rest of the calendar year. You’ll only be responsible for taxes.

23. Preferred Provider Plan
Services
Participating Provider
Annual maximum
out-of-pocket limit
$3,000 per person, $9,000 per family
Annual deductible
$300/person,
Maximum: $900/family
Office visit/urgent care
$17 copayment/visit
Emergency room
20% coinsurance
Hospitalization facility fee
The Preferred Provider Plan has set the standard for provider choice and is the most popular plan in the state.
This plan gives you the freedom to choose your own doctors and specialists from HMSA’s statewide provider network, which includes all major hospitals in Hawaii.
Our members like this plan because it’s simple and easy to use. You can go to any licensed provider in the state whether or not they participate with HMSA and seek specialty care without a referral. Although you can see any provider, we encourage you to seek care from HMSA participating providers to receive the maximum benefits and cost savings.
Participating providers are part of HMSA’s group of doctors who agree to charge less than nonparticipating providers (doctors who don’t have an agreement with HMSA). This amount is known as the eligible charge, which is the most a participating doctor can charge in agreement with HMSA.
If you see a nonparticipating provider, keep in mind that you’ll receive a lower level of benefit and your out-of-pocket expenses will be higher. Nonparticipating doctors don’t have an agreement with HMSA. They may charge you whatever they wish and you’ll be responsible for the copayment plus any costs above HMSA’s eligible charge.

24. Health Plan Hawaii HMO Services In-Network Annual maximum
out-of-pocket limit
$2,500 per person, $7,500 per family
Annual deductible
None
Office visit/urgent care
$20 copayment/visit
Emergency room
20% coinsurance
Hospitalization facility fee
Health Plan Hawaii Plus is an HMO, or health maintenance organization plan. With this plan, you’ll receive coordinated care from your primary care provider and health center. You’ll also have access to a large HMO provider network with over 1,700 doctors and other providers.
If you’re looking for a simple way to manage your health, this plan may be for you. The emphasis of an HMO plan like Health Plan Hawaii Plus is to maintain a close relationship with your PCP so they can coordinate your care and provide referrals to specialists as needed to keep you healthy.
In this plan, the office visit copayment is $20, there’s no annual deductible, and no charge for physician visits if you’re in the emergency room. For most services that HMSA helps pay for, such as hospitalization and surgery, you’ll pay 10 percent.

25. Health Plan Hawaii Choose a primary care provider (PCP)
Select a health center
Seeing a specialist
Self-referrals
There are some key differences with Health Plan Hawaii Plus.
You need to choose a primary care provider.
Since HMO plans like Health Plan Hawaii Plus are based on centralized care, you’ll need to choose a primary care provider or PCP.
You’ll develop an ongoing relationship with your PCP and they’ll become familiar with your medical history and health care needs. Each of your covered dependents can choose their own PCP and you have the flexibility of changing your PCP if you want to.
You’ll also need to select a health center.
Your health center is a group of private, independent doctors who provide health care services to members of an HMO plan. You’ll receive routine and specialty care from doctors and specialists in the health center you choose.
Your health center may be a single physical location, such as Kuakini Health Network, or a group of doctors who have offices at different locations, such as Hawaii Health Partners or Oahu Physicians Group. Again, your covered dependents can choose their own health centers.
What if you need a specialist?
You can visit a specialist in your health center without a referral. If your health center doesn’t have the specialist you need, your PCP can refer you to one outside of your health center. With that referral, services are covered.
If you see a specialist outside your health center without a referral from your PCP, you’ll be responsible for the entire cost.
What about self-referrals?
With Health Plan Hawaii Plus, there are instances for self-referrals.
If you have a life-threatening medical situation, call 911 or go to the nearest emergency room. These services will be covered. You’ll need to contact your PCP within 48 hours of receiving services for follow-up care.
You’re also covered when you seek mental health and substance abuse services from any HMSA participating behavioral health provider who you can find online or in the Health Plan Hawaii Plus directory.
The last instance for self-referral is for your annual vision exam. You must select an ophthalmologist or optometrist in HMSA’s network.

26. Plan Comparison Services
Preferred Provider Plan (participating provider)
Health Plan Hawaii
Annual maximum out-of-pocket limit
$3,000 per person,
$9,000 per family
$2,500 per person,
$7,500 per family
Annual deductible
$300/person,
$900/family
None
Office visit/
urgent care
$17 copayment/visit
$20 copayment/visit
Emergency room
20% coinsurance
Hospitalization facility fee
Here’s a quick comparison of your three health plan options. You can find all of this information in your benefits summary.
I encourage you to select the plan that best fits your health and financial needs.

27. Prescription Drug Benefit
CVS/caremark™ (Longs Drugs)
Local customer service
Large pharmacy network
ReadyFill at Mail®
ExtraCare Card®
CVS/caremark (known as Longs Drugs in Hawaii) is our pharmacy benefits manager. That means CVS/caremark processes prescription drug claims for members who have HMSA drug coverage.
Local customer service
Call center in Hawaii.
Mail-order prescriptions are sent from a local mail center instead of from the Mainland.
Large network
Largest pharmacy network in the state with more than 69,000 locations in Hawaii and on the Mainland.
ReadyFill at Mail
Automatic refills available for most long-term medications, excluding controlled substances and specialty drugs.
Request a new prescription from the prescribing doctor when your prescriptions are about to expire or when the last refill has been filled.
Stay informed about your prescription status with a phone call, , or text message.
ExtraCare Card
Save money when shopping at Longs Drugs stores, which are owned by CVS Health, or online at cvs-dot-com.
Receive a 20 percent discount on thousands of CVS/pharmacy Brand health-related items that are regularly priced at $1 or more.
Check your Longs receipt for additional coupons and discounts.

28. Essential Formulary Tier Description Member cost 30-day supply Tier 1
Mostly generic drugs
$7 copayment/prescription
Tier 2
Mostly preferred drugs
$30 copayment/prescription
Tier 3
Mostly other brand-name drugs
$75 copayment/prescription
Tier 4
Mostly preferred specialty drugs
$100 copayment/prescription
Tier 5
Mostly other brand-name specialty drugs
$200 copayment/prescription
90-day supply
Mail service – mostly generic drugs
$11 copayment/prescription
Mail service – mostly preferred drugs
$65 copayment/prescription
Mail service – mostly other brand-name drugs
Essential Prescription Formulary:
During this renewal period changes are being made to your HMSA drug plan. These changes are necessary to manage the rising costs of drugs and to continue giving you access to the medications you need at an affordable price. The main changes are that there are five tiers now instead of four, with specialty drugs in tiers 4 and 5.
The Essential Formulary is a “managed” formulary, meaning that all new drugs are reviewed for safety, efficacy, and cost effectiveness before they’re added to the formulary.
Each quarter, HMSA’s Pharmacy and Therapeutics Committee evaluates new drugs. This committee is comprised of local physicians from the community and HMSA medical directors.  
If a member needs a non-formulary drug, their doctor can ask us for an exception.
Like the Select Formulary, many prescription drugs are available via mail service except for specialty drugs. This service saves time and money if you take maintenance medications, which are those you take long-term for conditions such as high blood pressure or high cholesterol. You can even get a 90-day supply of maintenance medication at the lower mail-order rate.
When you travel on the Mainland, you can still fill your prescriptions. You’ll have access to 69,000 participating pharmacies nationwide and the same benefits as if you were in Hawaii.
(For non-grandfathered groups only) You have added protection with an annual out-of-pocket maximum for your prescription drugs. This maximum is $3,600 per person or $4,200 per family for the calendar year.

29. Save Money on Your Medications
Choose generic
Get a 90-day supply
Remember that you’re protected by your out-of-pocket maximum
There are several ways to save money on your medication. You can choose generic and/or request a 90-day supply. Remember to carefully follow the instructions to ensure you’re taking the recommended dose. You’re also protected by your out-of-pocket maximum, which is the most you’ll have to pay for covered drugs in a year.

30. Preferred Provider Plan & CompMED Health Plan Hawaii Plus
Vision Care
Benefit
Preferred Provider Plan & CompMED
Health Plan Hawaii Plus
Annual
eye exam
$10 copayment
$20 copayment
Basic lenses
Basic frames
$15 copayment/ 24 months
Contact lenses
$25 copayment
up to $130 maximum
Preferred Provider Plan and CompMED:
Copayment is $10 for both plans
Health Plan Hawaii Plus:
Copayment is $20 – the same as an office visit under your medical plan.
Glasses:
Same benefits for all three plans when you see an eye doctor who participates with HMSA.
Basic set of lenses are $10.
Frames every 24 months are $15. (This price excludes designer frames. You’ll be responsible for paying the extra cost.)
Additional features (tinting, scratch proofing, and invisible bifocals) aren’t covered by HMSA.
Contact lenses:
Copayment is $25.

31. Dental Care with HMSA Participating Provider Dental Program (PPO)
Dental Network Program (HMO)
hmsadental.com
HMSA is the only health plan that offers an integrated approach to medical and dental plans. I’ll explain more about this approach in a little while.
We offer two dental plans: Participating Provider Dental Program, which is a PPO plan, and our Dental Network program, which is an HMO plan.

32. Participating Provider Dental Program (PPO)
91% of Hawaii’s dentists participate with HMSA
Exceptional rollover benefit
Dental Services
Participating Provider Program
Calendar Year Deductible
$25 per person,
$75 per family
Calendar year maximum
$2,000
Preventive care
No cost
Routine care
30% coinsurance
Major care
50% coinsurance
Ortho care
$1,500 maximum
With our Participating Provider Dental Program, you choose your dentist. Finding a dentist is easy because about 90 percent of Hawaii’s dentists participate with HMSA.
And just like choosing a doctor in our network, you’ll pay less when you see an HMSA dentist than if you were to see a dentist who’s not part of HMSA. You can find HMSA dentists with the Find a Doctor tool on hmsa.com.
This plan helps pay for preventive care and major services. For detailed benefit information, you can review your plan comparison.
An amazing benefit of this plan is the rollover benefit. You can keep up to $350 of unused dental benefits at the end of the year and use it the following year. To do this, you would need to:
Receive at least one covered service during the calendar year.
Be an HMSA Participating Dental Program member on the last day of the calendar year.
In addition:
Your claims must be under $500.
You can accrue up to $1,000 in unused benefits from previous years.

33. Dental Network Program (HMO)
Hawaii Family Dental Centers
No annual benefit maximum
Preventive care at no cost
Low, fixed copayments
Orthodontics at special rates
Our Dental Network Program is our HMO dental plan. This plan lets you get dental services at Hawaii Family Dental Centers.
You’ll receive preventive care services at no charge. Most services that we help pay for are available at low, fixed copayments, making it easy for you to budget for your dental care. Orthodontics is also available at a special member rate.
Because your dental plan is separate from your medical plan, you can mix and match your medical and dental plans.
For example, you can choose:
Preferred Provider medical plan with the Participating Provider dental program.
Preferred Provider medical plan with the HMO dental plan.
Health Plan Hawaii Plus with the Participating Provider dental program.
Health Plan Hawaii Plus with the HMO dental plan.

34. HMSA’s Integrated Medical and Dental Plans
Oral health is related to overall health
Gum disease is related to chronic health conditions
HMSA is the only health plan in Hawaii that can truly integrate medical and dental services
Now let’s talk about the importance of integrated medical and dental coverage.
First, oral health is important for your total health. Oral health can affect your overall health.
Second, because HMSA has integrated medical and dental plans, we can analyze claims information and identify members who may need more dental care or support.
We reach out to certain members — such as those with coronary artery disease (CAD), diabetes, and gum disease — because research shows that there’s a relationship between gum disease and some chronic health conditions.

35. Enhanced Dental Benefits
Condition
Cleaning or periodontal maintenance visits every 3 months
Periodontal scaling once per quadrant every 24 months*
Prediagnostic oral cancer screening every 6 months**
Fluoride treatment every 3 months
Diabetes 
Coronary artery disease
Pregnancy
Oral cancer
Here are the enhanced benefits that members can receive.
Members who have diabetes, heart disease, or oral cancer and women who are pregnant may be eligible to receive additional dental services at no charge when they visit an HMSA participating dentist.
One major difference is that deductibles, copayments, coinsurance, and calendar-year benefit maximums don’t apply to in-network services as they would with our standard dental plan.
Out-of-network services will follow the plan’s out-of-network benefits. However, they won’t apply to the deductible and calendar-year benefit maximum.
* Periodontal maintenance and scaling available in plans that offer periodontal benefits. ** Oral cancer screening is a benefit for members who have had oral cancer.

36. Powerful Online Tools hmsa.com My Account HMSA’s Online Care® Cozeva®
Healthways Financial Well-Being Powered by Dave Ramsey
Another great benefit of being an HMSA member is the powerful online tools available to you. This includes:
hmsa.com
My Account on hmsa.com
HMSA’s Online Care
Cozeva
Healthways Financial Well-Being Powered by Dave Ramsey
Cozeva is a registered trademark of Applied Research Works, Inc.

37. hmsa.com Get the latest news and information Find a doctor
Learn more about your plan
View HMSA Center and office locations and hours
Go to HMSA’s website to:
Get the latest HMSA news and information.
Search for doctors, hospitals, and other providers.
Learn about and compare HMSA health plans.
Find customer service phone numbers and HMSA office locations and hours of operation.

38. Account Management View your claims history
Get medical plan information
Order prescription refills through the mail-order pharmacy
Request and print duplicate membership cards
Speak to doctors online or by phone with HMSA’s Online Care
Sign up for My Account to:
View your claims history.
Get medical plan information.
Order prescription refills through the mail-order pharmacy.
Request and print duplicate membership cards.
Speak to doctors online or by phone with HMSA’s Online Care.

39. HMSA’s Online Care Convenient care anywhere
Consult with a doctor 24/7, days a year
Secure and easy
For most plans, there’s low to no copayment
Log in to HMSA’s Online Care to: Consult with a doctor 24/7, 365 days a year using your computer or phone anywhere in Hawaii. It’s completely secure and easy. The best part is there’s no copayment for most plans (some plans still have a $10 copayment/10 minutes).

40. The Cozeva Advantage Message your doctor Request online appointments
Receive reminders for services
See your past appointments and prescribed medications
cozeva.com
With Cozeva, you can message your doctor, request appointments online, receive reminders for services, and see your past appointments and prescribed medications. Not all our providers participate in Cozeva, but the number is growing. Please ask your doctors if they participate.

41. Healthways Financial Well-Being Powered by Dave Ramsey
Learn to manage your finances
Save money
Improve your financial well-being
Healthways Financial Well-Being Powered by Dave Ramsey is a program that teaches you how to manage your finances. Access the program through My Account after completing the well-being survey.

42. HMSA365 Save money on health-related products and services all year
Browse by location and category at hmsa.com/well- being/hmsa365
Good health goes beyond visiting your doctor. With HMSA365, our members have access to discounts on fitness classes, health products, holistic and massage therapy, medical transportation, and more. To see a full list of discounts, go to hmsa.com/well-being/hmsa365.

43. Connect With Us myhmsa @askHMSA Stay connected with HMSA:
Like us on Facebook
Follow us on Twitter
Follow us on Instagram
And get updates on:
HMSA news
Community events
Healthy activities
Recipes
And more!

44. We’re Here For You Preferred Provider Plan & CompMED 948-6111
Health Plan Hawaii Plus
Oahu
Neighbor Islands 1 (800)
For HMSA Center and office locations and hours, go to hmsa.com/contact.
Thank you for choosing HMSA and for giving me this opportunity to tell you about our health plans and services.
If you have any questions, please call our Customer Relations department:
For Preferred Provider Plan and CompMED members, call
For Health Plan Hawaii Plus members, call
On the Neighbor Islands, call 1 (800) toll-free.
You can also visit us at our HMSA Centers and offices statewide. These locations are open just for you. For hours, go to hmsa.com/contact.

45. Welcome to Open Enrollment 2017
kp.org/hawaii

46. A healthy partnership Choice of top doctors Complete care
Care the way you want it

47. HMO Summary Benefits (Member Responsibility) Kaiser Facility
Deductible (Calendar)
N/A
Individual / Family
None
Coinsurance
10%
Out-of-Pocket Maximum
Includes coinsurance and copays (Med & Rx)
$2,500 / $7,500
Office Visit Copay
$20 copay
Preventive Care $0
Retail / Convenience Clinic
Urgent Care
$20 copay; 20% out of covered service area
Emergency Room
$100 copay
Chiropractic Care
Diagnostic Lab
$10 copay
Diagnostic X-Ray
Diagnostic Imaging (MRI, PET, CAT)
20% coinsurance
Inpatient Hospital
10% coinsurance
Outpatient Hospital
Prescription Drugs (In-Network)
Deductible
Retail Copay
$3 / $10 / $45 copay
Specialty Rx
$200 copay
3 Month Mail-Order Copay
$6 / $20 / $90 copay/ Specialty N/A

48. Highlights of some your 2017 HMO benefit changes:
Dependent Child Coverage While Away from Hawaii
All dependent children are now covered while they’re away from Hawaii for travel or study. This includes coverage of 10 primary care office visits and 10 prescriptions. The health plan subscriber must live in the Kaiser Permanente Hawaii service area.
Lower Copays for Generic Maintenance Drugs
We now offer prescription drug riders with generic maintenance drug copayments of $3 (reduced from $5).
Specialty Drugs
Certain prescription drug riders now have a $200 specialty drug copay.
Drugs Administered by Our Medical Staff
Prescribed drugs needing administration by medical staff are now covered at 20% coinsurance.
Hawaii Autism Law (also known as “Luke’s Law”)
The Hawaii State Law provided a summary definition of ABA, which states “Applied behavior analysis” (ABA) means the design, implementation, and evaluation of environmental modifications, using behavioral stimuli and consequences, to produce socially significant improvement in human behavior, including the use of direct observation, measurement, and functional analysis of the relations between environment and behavior.

49. Added Choice Benefits (Member Responsibility) Kaiser Facility
Out-of-Network
Deductible (Calendar)
Non-Embedded
Individual / Family
None
$100 / $300
Coinsurance
10%
Out-of-Pocket Maximum
Applies to supplemental charges as defined in the Plan Summary
$2,000 / $6,000
Office Visit Copay
$20 copay
20% coinsurance
Preventive Care $0
Retail / Convenience Clinic
Urgent Care
Emergency Room
$75 copay
Chiropractic Care
Diagnostic Lab
10% coinsurance
Diagnostic X-Ray
Diagnostic Imaging (MRI, PET, CAT)
Inpatient Hospital
$75 copay per day
Outpatient Hospital
Prescription Drugs (In-Network)
Kaiser Provider
Contracted Provider
Deductible
Retail Copay
$3 / $10 / $45 copay
20% not less than: $10 / $10 / $45
Specialty Rx
$200 Retail
20% not less than $200
3 Month Mail-Order Copay
$6 / $20 / $90 copay/ Specialty N/A

50. Your choice of top doctors
Choose or change your doctor at anytime

51. Care the way you want it

52. Your health anytime, anywhere
With My Health Manager you can:
check-in for appointments using your new digital membership card
see most lab test results
your doctor’s office
order prescription refills
monitor immunizations
schedule routine appointments with your personal physician
— and much more

53. Oahu

54. Maui

55. Big Island

56. New care access on the neighbor islands
Making care more convenient on Kauai beginning February 2016

57. Quality care for neighbor island members
24/7/365 specialty coverage
Support for all of our members before, during, and after your stay
Complimentary “concierge” service for those traveling to Oahu for specialty care
Air and ground transportation to and from Moanalua Medical Center

58. Call our Care Transition Team
Getting started
Call our Care Transition Team
Select a primary care physician
Make an appointment
Transfer your prescription
Care transition assistance
Monday—Friday, 9 a.m. to 5 p.m. (except holidays)

61. Optical 150 HMO Summary Added Choice Benefits (Member Responsibility)
Kaiser Facility
Allowance for glasses or contacts
All costs greater than $150 allowance once every calendar year
Added Choice
Next slide
Benefits (Member Responsibility)
Kaiser Facility
Out-of-Network
Allowance for glasses or contacts
All costs greater than $150 allowance once every calendar year
$50 total allowance for lenses, frames and contacts 61

62. Chiropractic, acupuncture, and massage benefits
As a Kaiser Permanente member, you get up to combined 12 visits per calendar year to participating chiropractors, acupuncturists, and massage therapists—all for a low $20 copay per visit. Services are provided by American Specialty Health Systems, Inc. practitioners1. As an added benefit, no referrals are required for chiropractic and acupuncture services. Massage Therapy does require Physician referral for medical necessity.
Next slide 62

63. Call our Care Transition Team
Getting started
Call our Care Transition Team
Select a primary care physician
Make an appointment
Transfer your prescription
Care transition assistance
Monday—Friday, 9 a.m. to 5 p.m. (except holidays)

64. Care and coverage together makes life easier
Questions?
Call our Customer Service Center, 8 a.m. to 5 p.m. weekdays, and 8 a.m. to noon on Saturday (closed holidays).
TTY for the hearing/speech impaired
kp.org/hawaii
(next slide)

65. Flexible Spending Accounts
Why use a Flexible Spending Account (FSA)? Set aside pre-tax money for predictable expenses:
Health Care FSA
Qualified Medical Expenses
$2,600
$500 carryforward limit
Dependent Care FSA
Dependents under age 13
$5,000 ($2,500 married filling separately)
100% use it or lose it provision

66. Life and AD&D Will Preparation 100% Employer Paid
1 X Salary to $250,000
Age Reductions:
To 65% at age 75
To 50% at age 80
Terms at Retirement
Travel Assistance
(888)
Will Preparation

67. Voluntary Life Employee $10,000 increments to $500,000
Not to exceed 7 X Salary
Guarantee Issue of $100,000
Spouse
$10,000 increments to $150,000
Guarantee issue of $30,000 under age 70
Child/Children
$10,000 (covers all your children 6 months up to age 26 and financially dependent)
If you are currently enrolled for less than the Guarantee Issue Amount, you can increase your coverage $10,000 without Evidence of Insurability

68. This election is separate from the election
Voluntary AD&D
All amounts are Guarantee Issue
Employee
$10,000 increments to $500,000
Spouse
$10,000 increments to $250,000
Identity Theft Program
Support 24/7
This election is separate from the election
for Voluntary Life

69. Hawaii Temporary Disability Insurance (TDI)
100% Employer Paid
Benefits begin after 7 days of disability
58% of weekly salary
Maximum weekly benefit of $570 (2016 maximum)
Benefits may continue for up to 26 weeks
Note: must have at least 14 weeks of Hawaii employment which the employee was paid for 20 hours or more and earned not less than $400 in 52 weeks preceding the first day of disability.

70. Short Term Disability 100% Employer Paid
Benefits begin after 13 days of disability
60% of weekly salary
Maximum weekly benefit of $1,385
Benefits may continue for up to 24 weeks

71. Long Term Disability 100% Employer Paid 60% of monthly base pay
Maximum monthly benefit of $6,000
Benefits begin after 180 days of disability
Benefits can continue to your Social Security Normal Retirement Age (SSNRA)
Cost of Living Adjustment (COLA) 3%
Retirement Savings 10%
Calculated on base salary

72. Life Assistance Plan Free benefit for you and your family
Counseling – up to three face to face visits per issue per year. Examples include:
Work Related Stress
Relationship or Marital Issues
Parent/Child Conflicts
Depression, Anxiety, Grief issues
Work Life Programs
Legal Consultation (30 minutes free)
Financial Information
Elder Care and Child Care
Available 24/7/365
(800)
Login: lap Password: member

73. Taking Action Make decisions
Read your Open Enrollment Materials and other information
Make a decision and complete your enrollment through Ultipro no later than November 21ST
Only enter the session if you want to make changes, you can view your election under the benefits summary
2016 Elections will continue for 2017 except for FSA contributions
Flexible Spending Account Elections DO NOT roll over. You must re-enroll to participate.

74. Questions
QUESTIONS….