If you want to continue coverage under HMSA you will have to:

a)    Accept a lower benefit coverage than you currently have, i.e., 80/20 reimbursements on hospital and doctor costs, and
b)    Also fill out new enrollment forms during the EUTF Open Enrollment ending on November 30th to select HMSA.

If you do nothing, and you are currently covered by HMSA, on December 1st your coverage will continue at the 90/10 benefit level but be administered under HMA.

You also have the option during this open enrollment to switch between indemnity coverage of either HMA or HMSA, to an HMO, either through Kaiser or HMSA.

Those currently covered by Kaiser need to do take no action during the open enrollment if they want to continue with Kaiser coverage, albeit at the new premium rates.

Read further for more details about the change between HMSA and HMA….

The health insurance benefit options and premium amounts for all public employees are determined by the EUTF.  Normally, open enrollments (where you are given the opportunity to change your selection of coverage) occur in the spring, but this year the employers’ contributions to the premium costs remained undermined pending the settlement of contracts.  The HSTA and HGEA contracts were settled without any change in the employer’s contribution rates from July 1, 2008.  This has shifted the burden of the premium to be paid, depending on the coverage chosen, upon the public employees (see the attached premium rates.)

In anticipation of the increase payments that public employees would have to make, the unions recommended that a lower cost option for health insurance be included.  The option would reduce the benefit coverage for the indemnity coverage with a preferred provider, e.g., HMSA, from the current level of benefits where the insurer paid 90% and the beneficiary paid 10% (90/10) to a split of 80% and 20% 80/20) for the covered hospital charges and doctor’s fees.

Currently, EUTF offers the 90/10 plan through two plans; HMA and HMSA.  HMSA is the familiar Blue Cross/Blue Shield, not-for-profit, health insurer.  HMA is an administrative section of the for-profit Summerlin Life & Health Insurance Company.  HMA administers the benefit payments for the EUTF.  The EUTF “self-funds” the insurance, so neither HMSA nor HMA are actually insuring the state against any losses or gains between the premiums collected from public employees and state or county employers and the benefits paid out.  Although the 90/10 benefit coverage was identical, the HMA had a lower administrative fee, thus a lower premium cost.  However, there are differences in the panels of participating physicians between HMA and HMSA.  Further, if you travel to the mainland, the Blue Cross system of the hospitals and physicians will not require any up-front cash payment for services; they’ll accept your HMSA card.  HMA also has a panel of participating hospitals and medical facilities on the mainland, but it is not as extensive.  Hospitals or doctors may be required to get telephone approval for your charges you incur, or you may have to pay for the medical services and then submit them for reimbursement upon returning to the Hawaii.

When the EUTF decided to add a lower cost 80/20 benefit plan, they felt they need to eliminate one of the 90/10 providers; either HMA or HMSA for technical reasons having to do with the number of code spaces on the EUTF computers.  The decision was made to let the 90/10 benefit plan remain with HMA, and have HMSA cover the 80/20 plan.  The unions did not want the 90/10 benefit plan to be eliminated all together, and they wanted it to remain the primary benefit level of coverage.  So, EUTF has made the 90/10 plan the default coverage under HMA Since anyone selecting the indemnity coverage was in a 90/10 plan, those having been covered under HMSA will now have the benefits provided through HMA. HMSA will no longer be granted a 90/10 plan option under the EUTF.

Related Documents:

EUTF General Notice for Distribution to Employees

EUTF Open Enrollment General Notice

EUTF Workload and Service Issues