Hawaii Health and Wellness
Hawaii employees enjoy many of the same benefits as other U.S. employees. Use the
Payroll,
Time Off,
Retirement Savings Plan,
Life and Disability Insurance
and
Discount
links to find more information.
Hawaii Health and Wellness benefits, however, are NOT the same as other US groups.
For Hawaii employees and their eligible dependents, the company offers Medical, Dental, Drug 10 and Optical 1 as a packaged benefit through the Kaiser Permanente Added Choice* Program. Contact your local HR department or Kaiser Permanente of Hawaii for details on your health and wellness benefit. For more information refer to the 2010 Kaiser Benefits Summary.
*A variety of options are available through the Kaiser Permanente Added Choice* Program.
Eligibility
Employees working 20 or more hours a week for four consecutive weeks are eligible for Medical, Dental, Drug 10 and Optical 1 coverage as a packaged benefit and EyeMed Vision Care benefits effective on the 1st day of the next consecutive month following the first day of work.
Medical
The Kaiser Permanente Added Choice* Program medical coverage includes in-network and out-of-network outpatient services, inpatient services, mental health/ substance abuse services, emergency services (initial treatment only)/ambulance services and chiropractic services. Below is a closer look at in-network and out-of-network benefits:
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In-Network
There are no deductibles and no lifetime maximums for in-network care, but all care and services must be medically necessary and prescribed or directed by a Kaiser Permanente physician and received from Kaiser Permanente facilities within the Hawaii service area.
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Deductibles: None
Lifetime Maximum: None
Office Visits: $15
*Supplemental charges maximum: $2,500/member, $7,500/family (3 or more members) per calendar year.
Preventive Services – Office Visit Copays
- Well-Baby (birth up to 2 years) – No charge
- Well-Child (Age 2 and older) – No charge (limited to one free preventive visit per calendar year)
- Well-Woman - No charge (limited to one free preventive visit per calendar year)
- Immunizations (age 19 and older) – No charge
*Member must retain their receipts and can ask for a Supplemental Charges Maximum envelope at their clinic. |
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Out-of-Network (Participating and Non-Participating)
You are subject to deductible and a lifetime maximum with out-of-network care, but your out-of-pocket limits are lower.
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Deductibles: $100/member; $300/family (3 or more members)
Lifetime Maximum for Out-of-Network Care: $1,000,000
Office Visit: 20% of maximum allowable charge (Plus any charges above maximum allowable charge, if applicable, for non-participating provider)
Out-of-Pocket Limits: $1,000/member, $3,000/family (3 or more members) per calendar year
Precertification: required three days prior to receiving certain services
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Important Numbers
Added Choice Helpline 800-238-5742
Press "1" for Out-of-Network Claims
Press "2" for Precertification
Press "3" for Customer Service Center
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Customer Service Center
Oahu 808-432-5955
Neighboring Islands 800-966-5955
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After-Hours Advice Line
Oahu 808-432-7700
Neighboring Islands 800-467-3011 |
Dental
Dental benefits are provided by Hawaii Dental Service which has the largest network of providers and includes 96% of all licensed dentist in the state. The plan is designed to help pay for professional dental care for you and your family and covers dental services and supplies up to $1,200 per covered participant per calendar year.
There are no deductibles to meet and dental coverage is provided as follows:
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Dental Service |
Covered By Plan |
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Preventive Care |
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100% of eligible fee for prophylaxis (cleaning) twice per calendar year |
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Restorative Care |
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70% of eligible fee for amalgam fillings
70% of eligible fee for composite fillings (limited to anterior teeth)
50% of eligible fee for crowns and gold restorations (once every 5 years when teeth cannot be restored with amalgam or composite fillings) |
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Oral Surgery |
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70% of eligible fee for extractions |
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Prosthodontics |
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50 % of eligible fee for fixed bridges, once every 5 years (age 16 or older)
50% of eligible fee for dentures (complete and partial) once every 5 years (age 16 and older) |
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Orthodontics |
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Dependents eligible through age 18
Maximum payable by HDS for eligible patient: $1,000 lifetime per case
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To use your dental benefits, simply present your Dental ID card to the participating dental office when you or a covered family member receive dental care. For a list of participating dental providers contact Hawaii Dental Service at: (808) 529-9248 or 800-232-2533 ext 248 or www.deltadentalhi.org
Prescription Drug
Hawaii employees participating in the Drug 10 program have the option of using in-network or participating out-of-network pharmacies.
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In-Network
$10 for each prescription not exceeding a 30-day consecutive supply or one dose of injectable drug. 50% of applicable charges for FDA approved contraceptive drugs and devices
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Out-of-Network (Participating pharmacies only)
20% of maximum allowable charge, but minimum $10 at participating pharmacy |
Optical 1
The Optical 1 program covers one pair eyeglasses or contacts every 24 months and eyeglass lenses may be changed after 12 months. Members have the option of using in-network or out-of-network providers.
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In-Network
Lenses: no charge
Frames: limited to less than $40
Contacts: limited to less than $45
Professional fees: limited to less than $70
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Out-of-Network (Participating and Non-Participating)
Limited to $50 total allowance for lenses, frames and contacts |
EyeMed Vision Care
Employees and their eligible dependents can enroll for this voluntary benefit and employee premiums will be payroll deducted.
To locate EyeMed Vision Care providers near you, call EyeMed Vision Care at 800-841-1220 to speak with an EyeMed customer service representative or visit www.enrollwitheyemed.com and click on "www.enrollwitheyemed.com link for the Plus Network of Providers". If you enroll for vision benefits, you will receive an ID card from EyeMed Vision Care. Always carry your ID card and present it to the vision care provider when receiving care. Also, once you have enrolled with EyeMed, you will want to register on the secured site at www.eyemedvisioncare.com to view your personal vision care benefit information.
EyeMed Vision Care's network of providers includes private practicing optometrists, ophthalmologists, opticians, and many retail chains, including the nation's leading optical retailer, LensCrafters®. Here is a more detailed description of your vision care benefit.
LifeManagement Program
Magellan Health Services administers the LifeManagement Program. LifeManagement professionals provide confidential short-term counseling and work/life resources and referrals. Access the LifeManagement program online or speak with a trained consultant by calling 800-980-2273.
ID Cards
Hawaii employees participating in the Kaiser Permanente Added Choice* Program are issued two ID cards — one for medical/drug/optical and one for dental; EyeMed Vision Care will mail ID cards to your home address if you elect vision care benefits.
Enrollment
First time enrollment is necessary for all new employees by completing the Benefits Enrollment Form that is mailed to your home address. Completed forms must be returned to your local HR department by the due date printed on the form.
In addition to first time enrollment, annual Open Enrollment takes place in the fall to allow for changes to your benefit elections with coverage effective January 1st.
Life-Changing Events
During your employment with the company, you may experience life-changing events, such as getting married or divorced or having a child, that allow you to change your benefits elections. When these life-changing events occur, you will have an opportunity to make certain adjustments to your benefits by notifying your local HR department and submitting a Benefits Enrollment Form and documentation within a specified period of time.
Please Note: The UnitedHealthcare, Delta Dental and Express Scripts benefits described on this site DO NOT APPLY to Hawaii employees.
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