Benefit Plans

Medical Benefit Plans

All plans share the same large provider network, meaning you have the freedom to choose your physician and get great coverage no matter which plan you have.

UHA 3000

Focused on keeping you well

UHA 3000 was Hawaii's first health insurance plan to offer full, complete, 100-percent coverage for wellness and preventive medicine. It is also UHA's first health plan to offer a deductible.

Use the deductible for those larger benefits like inpatient and hospital services. Most other services are covered at 80% of eligible charge or a fixed low co-payment, except preventive services such as immunizations, screenings, annual exams and wellness programs for which the deductible does not apply.

 

arrow iconUHA 3000 Medical Benefits Guide (MBG)

Essential Health Benefits (EHB)

arrow iconUHA 3000-S

UHA 3000 Plan Quick View

  • No co-payment for wellness and preventative care
  • Fixed low co-payments for other services
  • $200 deductible for inpatient and hospital services
  • 80% of EC for most other services
  • Choose from a large provider network
  • Complementary alternative medicine benefits

UHA 600

The traditional PPO plan

UHA 600 is very simply the most traditional health plan. Have peace of mind that you can choose your preferred provider from our extensive provider network, and most of your benefits will be covered at 90% of eligible charge with the exception of wellness and preventive care which is paid at 100%.

arrow iconUHA 600 Medical Benefits Guide (MBG)

Essential Health Benefits (EHB)

arrow iconUHA 600-S

UHA 600 Plan Quick View

Complementary Alternative Medicine (CAM)

As part of your benefits, visits to participating chiropractors or acupuncturists are covered under any of the medical plans we offer.

  • $10 co-payment per visit for either chiropractic or acupuncture services with a participating provider
  • 50% of eligible charge for the first set of x-rays ordered by a participating chiropractor
  • $500 maximum benefit per calendar year1

Find a participating chiropractor: please refer to UHA Provider Directory Search

References:
  • EC = Eligible charge. Refer to your Medical Benefits Guide for detailed definition.
  • 1. Combined for chiropractic and acupuncture services, both participating and non-participating.

Benefit Plan Comparison

The following chart displays a comparison of plan provisions and benefits when seeing a participating provider1.

 
Plan Provisions1 UHA 3000 UHA 600
Dependent child coverage Up to age 26 Up to age 26
Annual Deductible2 $200 per person
$600 per family
None
Annual Maximum Out-of-Pocket $2,200 per person
$6,600 per family
$2,500 per person
$7,500 per family
Annual / Lifetime Maximum 3 Unlimited Unlimited
     
 

MEDICAL SERVICES
UHA 3000
You Pay
UHA 600
You Pay
PREVENTIVE CARE SERVICES†4
 
Physical Exam (office visit)
    once per calendar year
No co-payment
Preventive Screening Services:
    Mammography, Pap Smear, PSA Test
Well Child Care Visit
Childhood Immunizations
Adult Immunizations
Screening Laboratory Services - Outpatient
     
MATERNITY SERVICES
UHA 3000 UHA 600
**Maternity care No co-payment 10% of EC*
Birthing room No co-payment
Newborn nursery 10% of EC*
     
DISEASE MANAGEMENT PROGRAMS
UHA 3000 UHA 600
Smoking Cessation Program No co-payment
Asthma Education Program
Diabetes Self-Management Training & Education Program
Nutritional Counseling Programs
 
PHYSICIAN SERVICES
UHA 3000 UHA 600
Physician Office Visit $12 co-payment 10% of EC*
     
HOSPITAL SERVICES UHA 3000 UHA 600
Room & Board (semi-private room) 20% of EC*; deductible applies 10% of EC*
Ancillary Inpatient Services
Laboratory & Pathology - Inpatient
 
EMERGENCY SERVICES UHA 3000 UHA 600
Emergency Room Services 20% of EC*; deductible applies 10% of EC*
Ambulance (ground or inter-island air) 20% of EC*
     
COMPLEMENTARY ALTERNATIVE MEDICINE UHA 3000 UHA 600
Chiropractic/Acupuncture Services $10 co-payment per visit
Benefits limited to treatment of conditions of the neuromusculoskeletal system by licensed providers First set of x-rays at 50% of EC*; full charge for
add’l sets; $500 combined maximum per
calendar year
  1. The information above is intended to provide a condensed explanation of UHA medical plan benefits. Please refer to the appropriate Medical Benefits Guide (MBG) for complete information on benefits and provisions. In case of a discrepancy between this comparison and the language contained in the MBG, the MBG will take precedence.
  2. Annual deductible does not apply to all services. Refer to your Medical Benefits Guide to verify which services apply.
  3. No annual or lifetime maximum.
  4. All U.S. Preventive Services Task Force (USPSTF) A and B recommended screening services are covered at 100% as required under the provisions of the Patient Protection and Affordable Care Act (ACA).

  UHA 3000 annual deductible does not apply 

*EC = Eligible Charge. Refer to your Medical Benefits Guide for detailed definition.

**Covered, including prenatal, false labor, delivery, and postnatal services provided by your physician or certified nurse midwife. Maternity care does not include related services such as nursery care, labor room, hospital room and board, diagnostic testing, and other lab work and radiology. Please refer to the specific benefits for more information on those services.

Dental Benefit Plans

Hawaii Dental Service

Hawaii Dental Service is the first and largest nonprofit dental service corporation in Hawaii providing dental benefit plans to more than a half million members. More than 95% of all licensed, practicing dentists in Hawaii participate with HDS, creating the largest network of dentists in the state.

HDS is part of Delta Dental, the largest dental insurer in the nation, and that means you can receive dental coverage from participating dentists when you and your family are on the Mainland for school, work or vacation.

Find a HDS dentist

We offer a variety of plans through HDS:
 

For Large Groups (51 or more employees)

For Small Groups (50 or less employees)

Vision Benefit Plans

Vision 1001

  • Eye Examination & Refractions: Plan pays 100% of the eligible charge for one eye examination and one refraction per member, per calendar year
  • Increased appliance benefit: $130 per calendar year towards combination of eyeglasses, contact lenses, frames, and/or lenses purchases.

View Vision 100 Plan summary

Limitations and Exclusions
Contact lens fittings, and repair or replacement of frame parts and accessories are not a covered benefit. Sunglasses, prescription inserts for diving masks, non-prescription industrial safety goggles, and tinting of glasses are excluded. Refer to your plan summary description for specific information on vision plan benefits.

References:
  1. The vision benefit reimbursement is the same for participating and non-participating providers for all plans. The provider must be a licensed Ophthalmologist (M.D.) or Optometrist (O. D.).

Prescription Drug Benefits

Listed below are details of our Drug Plan S. Contact Sales should you have any questions about our prescription drug plan.

UHA's drug formulary provides you with a list of generic and preferred brand-name products. View a full list of our Drug Formulary here.

Prescription Drug Co-payment Matrix

  Drug Plan S
Annual Maximum $3,850 per person or $5,200 per family**
Generic $10.00
Preferred Brand $20.00
Non-Preferred Brand $40.00
  All Drugs Over $250 =
20% of EC*
Drug Plan Flyer (click to view) Drug Plan S (eff. 2016)

 

References:

*EC = Eligible Charge. Refer to your Medical Benefits Guide for detailed definition.

The information above is intended to provide a condensed explanation of UHA drug plan benefits. Please refer to the appropriate drug plan flyer for complete information on benefits and provisions. In case of a discrepancy between the comparison and the language contained in the applicable drug plan flyer, the applicable drug plan flyer will take precedence.

**When co-payments reach $3,850 per person or $5,200 per family in any calendar year, all drug plans will pay 100% of the eligible charge of covered drugs for the remainder of that calendar year. Excludes mandatory generic substitution or other DAW penalties.

If a Preferred or Non-Preferred Covered Drug is obtained when a generic equivalent is available, the member is responsible for (i) the difference in Eligible Charge between the Preferred or Non-Preferred Brand Covered Drug, and (ii) the generic co-payment.

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