Hawaii associate medical,
prescription & vision coverage
IMA associates residing in Hawaii have the option of two great medical plans to fit their needs.
| Plan Features | Kaiser HMO | HMSA PPO |
|---|---|---|
| In-Network Only | In-Network | |
| Network Access | Kaiser Network | HMSA Network |
| Annual Deductible Individual/Family | None | None |
| Annual Out-of-Pocket Maximum Individual/Family | $2,500 / $7,500 | $2,500 / $7,500 |
| FSA Eligibility | General Purpose Healthcare and/or Dependent Care FSA | General Purpose Healthcare and/or Dependent Care FSA |
| You pay: | You pay: | |
| Preventive Care Visit | No cost | No cost |
| Telemedicine | Cost share depending on services rendered | Deductible and copays vary depending on services rendered |
| Primary Care Visit | $15 copay | $12 copay |
| Specialist Visit | $15 copay | $12 copay |
| Lab & X-ray | Simple: $15 copay; Complex: 20% after deductible |
Inpatient: 10%; Outpatient: 20% |
| Urgent Care | $15 copay | $12 copay |
| Emergency Room | 20% | 20% |
| Inpatient/Outpatient Hospital Services | 20% | 10% |
| Bariatric Surgery Coverage | 20% of applicable charges when received in a total care service setting | 10% |
| Infertility Services | $15 copay; 20% IVF | Some services may be covered. Contact carrier for details. |
| Prescription Drugs: Retail (up to a 30-day supply) | ||
| Generic | $3 copay maintenance, $10 copay other generic | $7 copay |
| Preferred Brand Formulary | $45 copay | $30 copay |
| Non-Preferred Brand Formulary | $45 copay | $30 copay |
| Specialty/Self-Injectables | $200 copay | $100 copay |
| Prescription Drugs: Mail Order (up to a 90-day supply) | ||
| Generic | $20 copay | $11 copay |
| Preferred Brand Formulary | $90 copay | $65 copay |
| Non-Preferred Brand Formulary | $90 copay | $65 copay |
| Specialty/Self-Injectables | Not covered | Not covered |
*Includes coverage for IVF, GIFT and ZIFT.
Vision coverage is dependent on which medical plan is selected. Provided coverage is as follows:
| Plan Features | Kaiser Vision Plan | HMSA Vision Plan |
|---|---|---|
| In-Network | In-Network | |
| You pay: | You pay: | |
| Exam every 12 months | $15 copay | $10 copay |
| Prescription Glasses Frames Lenses Multifocal Lenses |
Amount above $150 allowance; every 12 months | $110 allowance; every 24 months $25 copay; every 12 months |
| Contact Lenses every 12 months (in lieu of lenses and frames) | Amount above $150 allowance | $110 allowance |
| Plan Type | 2025 – 2026 Medical & Prescription Plan Premiums | ||
|---|---|---|---|
| Employee Only | Employee + 1 Dependent | Employee + 2 or more Dependents | |
| Kaiser HMO | $16.00 | $110.50 | $220.50 |
| HSMA PPO | $17.00 | $137.00 | $274.00 |
