Hawaii health plan · 2025

HMSA Platinum PPO · 18350HI0880001

Hawaii Medical Service Association offers this marketplace health insurance plan (Plan ID 18350HI0880001) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Platinum Plan type: PPO CSR: Limited Cost Sharing Plan Variation Issuer: Hawaii Medical Service Association
Telehealth Data pending HSA eligible No Dental Not listed Vision Adult/Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 88.04% (11.96% member share on average). Learn about AV methodology.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$394 – $1544

Before subsidies

Estimate after subsidies

Deductible

$0

$0 per group

See deductible details

Max out-of-pocket

$4,300

$8600 per group

Review MOOP rules

Office visits

Primary care $10.00
Specialist $20.00
HSA Not eligible

Drug tiers

Generic $5.00
Preferred brand $10.00

View formulary tiers

$539 / mo before subsidies

≈ $6470 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1709 / mo before subsidies

≈ $20504 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$2069 / mo before subsidies

≈ $24832 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1315 / mo before subsidies

≈ $15781 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

0.00%

Emergency Room Services

$100.00

Durable Medical Equipment

10.00%

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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Hawaii). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Limited Cost Sharing Plan Variation plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

0.00%

Emergency Room Services

$100.00

Durable Medical Equipment

10.00%

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 18350HI0880001
Coverage year 2025
State Hawaii
Issuer Hawaii Medical Service Association
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 18350HI0880001-03
Available variants

Standard Off Exchange Plan · 18350HI0880001-00

Standard On Exchange Plan · 18350HI0880001-01

Open to Indians below 300% FPL · 18350HI0880001-02

Open to Indians above 300% FPL · 18350HI0880001-03
Last plan update Wed, 14 Aug 2024 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Hawaii N/A
PCPs in Hawaii N/A
Telehealth support Data pending
Nationwide providers N/A

Provider network(s)

Providers Hawaii All US states
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A

Drug coverage overview

4,688 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
PREFERRED-GENERIC-DRUGS 2,676
NON-PREFERRED-BRAND-DRUGS 1,091
DIABETIC-SUPPLIES 629
NON-PREFERRED-SPECIALTY-DRUGS 292
Prior authorization Drugs
Required 734
Not Required 3,954
Step therapy Drugs
Required 43
Not Required 4,645
Quantity limits Drugs
Has Limit 635
No Limit 4,053

Customer highlights

What stands out for members

  • Issuer: Hawaii Medical Service Association · Plan ID 18350HI0880001 · 2025 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 18350HI0880001-03 (Open to Indians above 300% FPL) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

Coverage details pending

nan

Exclusions: nan

Diabetes Education

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Home Health Care Services

10.00%
Tier 1 in-network 10.00%
Out-of-network 30.00%

Limit: 150.0 Visit(s) per Year

nan

Exclusions: nan

Laboratory Outpatient and Professional Services

$30.00
Tier 1 in-network $30.00
Out-of-network 30.00%

nan

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

$10.00
Tier 1 in-network $10.00
Out-of-network 30.00%

nan

Exclusions: nan

Preventive Care/Screening/Immunization

0.00%
Tier 1 in-network 0.00%
Out-of-network 30.00%

Quantitative limit units apply, see EHB

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

$10.00
Tier 1 in-network $10.00
Out-of-network 30.00%

nan

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

$10.00
Tier 1 in-network $10.00
Out-of-network 30.00%

The therapy is short-term, generally not longer than 90 days.

Exclusions: nan

Rehabilitative Speech Therapy

$10.00
Tier 1 in-network $10.00
Out-of-network 30.00%

nan

Exclusions: nan

Specialist Visit

$20.00
Tier 1 in-network $20.00
Out-of-network 30.00%

nan

Exclusions: nan

Urgent Care Centers or Facilities

$15.00
Tier 1 in-network $15.00
Out-of-network 30.00%

nan

Exclusions: nan

X-rays and Diagnostic Imaging

$30.00
Tier 1 in-network $30.00
Out-of-network 30.00%

nan

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

10.00%
Tier 1 in-network 10.00%
Out-of-network 30.00%

nan

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

$350.00
Tier 1 in-network $350.00
Out-of-network 30.00%

nan

Exclusions: nan

Dialysis

10.00%
Tier 1 in-network 10.00%
Out-of-network 30.00%

nan

Exclusions: nan

Durable Medical Equipment

10.00%
Tier 1 in-network 10.00%
Out-of-network 30.00%

nan

Exclusions: nan

Emergency Room Services

$100.00
Tier 1 in-network $100.00
Out-of-network $100.00

nan

Exclusions: nan

Emergency Transportation/Ambulance

10.00%
Tier 1 in-network 10.00%
Out-of-network 30.00%

nan

Exclusions: nan

Hospice Services

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Inpatient Hospital Services (e.g., Hospital Stay)

$350.00 Copay per Stay
Tier 1 in-network $350.00 Copay per Stay
Out-of-network 30.00%

nan

Exclusions: nan

Inpatient Physician and Surgical Services

$150.00
Tier 1 in-network $150.00
Out-of-network 30.00%

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

$350.00 Copay per Stay
Tier 1 in-network $350.00 Copay per Stay
Out-of-network 30.00%

nan

Exclusions: nan

Mental/Behavioral Health Outpatient Services

$10.00
Tier 1 in-network $10.00
Out-of-network 30.00%

nan

Exclusions: nan

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

$150.00
Tier 1 in-network $150.00
Out-of-network 30.00%

nan

Exclusions: nan

Outpatient Rehabilitation Services

$10.00
Tier 1 in-network $10.00
Out-of-network 30.00%

nan

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

$150.00
Tier 1 in-network $150.00
Out-of-network 30.00%

nan

Exclusions: nan

Radiation

10.00%
Tier 1 in-network 10.00%
Out-of-network 30.00%

nan

Exclusions: nan

Skilled Nursing Facility

$150.00 Copay per Stay
Tier 1 in-network $150.00 Copay per Stay
Out-of-network 30.00%

Limit: 120.0 Days per Year

nan

Exclusions: nan

Substance Abuse Disorder Inpatient Services

$350.00 Copay per Stay
Tier 1 in-network $350.00 Copay per Stay
Out-of-network 30.00%

nan

Exclusions: nan

Substance Abuse Disorder Outpatient Services

$10.00
Tier 1 in-network $10.00
Out-of-network 30.00%

nan

Exclusions: nan

Transplant

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Mental health & substance use

Behavioral health visits and substance use treatment.

Autism Spectrum Disorders

No Charge
Tier 1 in-network No Charge
Out-of-network 30.00%

nan

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Hearing Aids

10.00%
Tier 1 in-network 10.00%
Out-of-network 30.00%

1 hearing aid per ear every 60 months.

Exclusions: nan

Major Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Prenatal and Postnatal Care

10.00%
Tier 1 in-network 10.00%
Out-of-network 30.00%

nan

Exclusions: nan

Routine Eye Exam for Children

No Charge
Tier 1 in-network No Charge
Out-of-network $35.00

Member owes all charges over $35 when seeing a nonpar provider

Exclusions: nan

Well Baby Visits and Care

No Charge
Tier 1 in-network No Charge
Out-of-network 30.00%

Quantitative limit units apply, see EHB

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$5.00
Tier 1 in-network $5.00
Out-of-network $5.00, 20.00%

nan

Exclusions: nan

Non-Preferred Brand Drugs

$50.00
Tier 1 in-network $50.00
Out-of-network $50.00, 20.00%

nan

Exclusions: nan

Preferred Brand Drugs

$10.00
Tier 1 in-network $10.00
Out-of-network $10.00, 20.00%

nan

Exclusions: nan

Specialty Drugs

$150.00
Tier 1 in-network $150.00
Out-of-network 100.00%

Costshare for preferred specialty drugs. Refer to plan brochure for non-preferred specialty drug costshare information.

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

$150.00
Tier 1 in-network $150.00
Out-of-network 30.00%

nan

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Check-Up for Children

Coverage details pending

nan

Exclusions: nan

Infusion Therapy

10.00%
Tier 1 in-network 10.00%
Out-of-network 30.00%

nan

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

No Charge
Tier 1 in-network No Charge
Out-of-network 30.00%

Counseling for diagnosed eating disorder by a recognized licensed dietician

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

Coverage details pending

nan

Exclusions: nan

Prosthetic Devices

10.00%
Tier 1 in-network 10.00%
Out-of-network 30.00%

nan

Exclusions: nan

Routine Dental Services (Adult)

Coverage details pending

nan

Exclusions: nan

Weight Loss Programs

Coverage details pending

nan

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

10.00%
Tier 1 in-network 10.00%
Out-of-network 30.00%

nan

Exclusions: nan

Acupuncture

$20.00
Tier 1 in-network $20.00
Out-of-network 100.00%

Limit: 12.0 Visit(s) per Year

nan

Exclusions: nan

Allergy Testing

10.00%
Tier 1 in-network 10.00%
Out-of-network 30.00%

nan

Exclusions: nan

Applied Behavior Analysis Based Therapies

No Charge
Tier 1 in-network No Charge
Out-of-network 30.00%

Precertification is required.

Exclusions: nan

Bariatric Surgery

$150.00
Tier 1 in-network $150.00
Out-of-network 100.00%

nan

Exclusions: nan

Cosmetic Surgery

Coverage details pending

nan

Exclusions: nan

Eye Glasses for Children

No Charge
Tier 1 in-network No Charge
Out-of-network $85.00

Lenses limited to one par per calendar year. Frames limited to one frame every 24 months. Member owes all charges over $85 when seeing a nonpar provider

Exclusions: nan

Gender Affirming Care

10.00%
Tier 1 in-network 10.00%
Out-of-network 30.00%

Precertification is required.

Exclusions: nan

Habilitation Services

$10.00
Tier 1 in-network $10.00
Out-of-network 30.00%

Supplementing with the federal definition of habilitative services: Health care services that help a person keep, learn, or improve skills and functioning for daily living. Examples include therapy for a child who is not walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology and other services for people with disabilities in a variety of inpatient and/or outpatient settings.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

$100.00
Tier 1 in-network $100.00
Out-of-network 30.00%

Precertification is required.

Exclusions: nan

Infertility Treatment

$150.00
Tier 1 in-network $150.00
Out-of-network 30.00%

Infertility treatment is covered. Refer to the plan brochure for covered services, criteria, and limitations.

Exclusions: nan

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Orthodontic Services to Treat Orofacial Anomalies

No Charge
Tier 1 in-network No Charge
Out-of-network No Charge

Benefits are limited to a maximum of $6,930 per treatment phase

Exclusions: nan

Private-Duty Nursing

Coverage details pending

nan

Exclusions: nan

Reconstructive Surgery

$150.00
Tier 1 in-network $150.00
Out-of-network 30.00%

nan

Exclusions: nan

Routine Eye Exam (Adult)

$10.00
Tier 1 in-network $10.00
Out-of-network $35.00

Limit: 1.0 Exam(s) per Year

Plan will pay up to $35 for out-of-network providers

Exclusions: nan

Routine Foot Care

Coverage details pending

nan

Exclusions: nan

Telehealth

$10.00
Tier 1 in-network $10.00
Out-of-network 30.00%

nan

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

Coverage details pending

nan

Exclusions: nan

Variant attributes

HMSA Platinum PPO · Variant 18350HI0880001-03

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Limited Cost Sharing Plan Variation

HIOS Product ID

18350HI088

Metal Level

Platinum

Plan ID (Standard Component ID with Variant)

18350HI0880001-03

Plan Marketing Name

HMSA Platinum PPO

Plan Variant Marketing Name

HMSA Platinum PPO Limited Cost Sharing Plan

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

18350

Issuer Marketplace Marketing Name

HMSA

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

Yes

Network ID

HIN002

Out of Country Coverage

Yes

Out of Country Coverage Description

Covered

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Covered

Service Area ID

HIS001

State Code

HI

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.880407033355827

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$300

SBC Scenario, Having a Baby, Copayment

$800

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$80

SBC Scenario, Having Diabetes, Copayment

$400

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$100

SBC Scenario, Treatment of a Simple Fracture, Copayment

$300

SBC Scenario, Treatment of a Simple Fracture, Deductible

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

$8600 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

$4300 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

$4,300

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

0.00%

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$8600 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$4300 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$4,300

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

$8600 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

$4300 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

$4,300

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

HIF001

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

No

Design Type

Design 1

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy

EHB Percent of Total Premium

0.9838

First Tier Utilization

100%

Import Date

2024-08-14 20:01:41

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Plan Effective Date

2025-01-01

Plan Type

PPO

QHP/Non QHP

Both

Source Name

SERFF

Plan ID

18350HI0880001

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group

$0 per group

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person

$0 per person

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual

$0

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group

$0 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person

$0 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$0

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

$0 per group

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

$0 per person

Combined Medical and Drug EHB Deductible, Out of Network, Individual

$0

Unique Plan Design

No

Wellness Program Offered

Yes

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Hawaii?

HMSA Platinum PPO (18350HI0880001) is a Platinum PPO from Hawaii Medical Service Association in Hawaii for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does HMSA Platinum PPO support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is HMSA Platinum PPO HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Adult, Child.

Does HMSA Platinum PPO support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with HMSA Platinum PPO?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy.

Is there out-of-country coverage for HMSA Platinum PPO?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Covered

Does HMSA Platinum PPO cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Covered

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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