HMSA PPO Medical Plan
Your PPO medical plan is offered through HMSA. You may see any provider you choose, but you’ll save the most when you see in-network providers.
HMSA PPO Medical Plan Overview
Deductible and Out-of-Pocket Maximum
If you enroll in family coverage, the HMSA PPO Medical Plan has an embedded deductible, meaning each family member has their own individual deductible to meet. Once a family member meets their deductible, the plan begins paying for that person. Once any combination of family members meets the family deductible, the plan starts paying for all covered family members.
The plan also has an embedded out-of-pocket maximum, which works in the same way: Once an individual in the plan meets their own out-of-pocket maximum, the plan pays the rest of their covered healthcare costs for the year.
| Plan Feature or Covered Service | In-Network | Out-of-Network |
| Annual deductible - Individual | $350 | $350 |
| Annual deductible - Family | $1,050 | $1,050 |
| Annual out-of-pocket maximum - Individual | $3,000 | $3,000 |
| Annual out-of-pocket maximum - Family | $9,000 | $9,000 |
| Coinsurance | 80% | 80% |
| Preventive care | No cost | Covered up to the HMSA allowed amount |
| Primary care physician visit | $17 copay* | $17 copay* Covered up to the HMSA allowed amount |
| Specialist office visit | $17 copay* | $17 copay* Covered up to the HMSA allowed amount |
| Urgent care | $17 copay* | $17 copay* |
| Emergency room | 80%* | 80%* |
| Inpatient hospital | 80%* | 80%* up to the HMSA allowed amount |
| Outpatient surgery | 80%* | 80%* up to the HMSA allowed amount |
| Outpatient laboratory work and X-rays | 80%* | 80%* up to the HMSA allowed amount |
* After deductible
Register Online With HMSA
Create an online account with HMSA to access helpful tools and resources for managing your healthcare. You can view lab results, find a doctor, manage your explanations of benefits, and explore tips for healthy living.
Visit https://www.hmsa.com to get started. You will need the member identification number assigned by HMSA to register for online services and the mobile app.
Prescription Drug Coverage
Your prescription drug costs depend on the type of medication and whether you fill it at a retail pharmacy or through mail order. The plan lists costs for a 30-day supply at retail pharmacies and a 90-day supply through mail order.
| Medication type | In-network | Out-of-network |
| Generic | Retail: $7 Mail order: $11 | Retail: $7 + 20% coinsurance Mail order: Not available |
| Preferred brand-name | Retail: $30 Mail order: $65 | Retail: $30 + 20% coinsurance Mail order: Not available |
| Non-preferred brand-name | Retail: $30 + $45 other brand-name cost share Mail order: $200 | Retail: $30 + 20% coinsurance + $45 other brand-name cost share Mail order: Not available |
| Specialty | Retail: $100 Mail order: Not available | Retail: Not available Mail order: Not available |
Using Your Prescription Drug Coverage
Visit HMSA online to review covered medications, compare cost estimates, find an in-network pharmacy, or learn how to use mail-order delivery. You can also review other important information about your prescription drug coverage. Visit https://www.hmsa.com or call 800-776-4672.