Hawaii Medical Plans

Two T-Mobile Employees smiling and pointing at the camera

Hawaii Medical Insurance

If you live in Hawaii, your medical, dental, and vision coverage is provided through HMSA. You can choose between two medical plan options:

Health Maintenance Organization (HMO) plan: Covers in-network care only (except emergencies)
Preferred Provider Organization (PPO) plan: Covers both in-network and out-of-network care

Both plans include coverage for preventive care, office visits, prescription drugs, and other healthcare services. The biggest difference between the plans is whether you want coverage for out-of-network providers.

Provider Search

A key factor in choosing a plan is whether your providers are in-network.

Online Provider Directory: hmsa.com
Phone: (800) 776-4672

Hawaii Medical Plans at a Glance

	HMSA HMO	HMSA PPO
Coverage	In-network only (except emergencies)	In-network and out-of-network
How You Pay	Mostly copays ($20 for primary care and specialists)	Copays ($12 for office visits) and coinsurance New for 2027: $17 copay for urgent care
Deductible	None	No deductible for in-network care; deductible applies for out-of-network care
Out-of-Pocket Max	$2,500 individual/$7,500 family	$2,500 individual/$7,500 family
Prescription Out-of-Pocket Max	$3,600 individual/$4,200 family	$3,600 individual/$4,200 family
Specialist Referrals	Required	Not required
Paycheck Cost	Lower	Higher

HMSA Bi-Weekly Employee Contributions for Medical Plans

Plan Year: 01/01/2026 – 12/31/2026

Coverage Election	Employee	Employer	Employee	Employer
Employee Only	$8.00	$286.15	$8.00	$289.52
Employee Only plus Spouse	$112.00	$561.14	$119.72	$561.14
Employee Only plus Children	$91.00	$467.25	$97.41	$467.25
Employee Only plus Family	$133.00	$804.86	$143.76	$804.86
Domestic Partner¹	$104.00	$274.99	$111.72	$271.62
Domestic Partner Child¹	$83.00	$181.10	$89.41	$177.73
Additional Working Partner Premium²	$46.15		$46.15
¹Domestic Partner deductions are taken on a post-tax basis, and employee pays tax on the employer portion of the contribution. ²The Working Partner Premium amount is in addition to the employee contributions shown in the table above.

HMSA Bi-Weekly Employee Contributions for Medical Plans

Plan Year: 01/01/2027 – 12/31/2027

Coverage Election	HMSA HMO		HMSA PPO
Coverage Election	Employee	Employer	Employee	Employer
Employee only	$8.00	$324.72	$8.00	$328.52
Employee plus Spouse	$130.05	$631.39	$138.74	$631.39
Employee plus Children	$105.66	$525.84	$112.87	$525.84
Employee plus Family	$154.43	$906.44	$166.53	$906.44
Domestic Partner¹	$122.05	$306.67	$130.74	$302.87
Domestic Partner Child¹	$97.66	$201.12	$104.87	$197.32
Additional Working Partner Premium²	$46.15		$46.15
¹Domestic Partner deductions are taken on a post-tax basis, and employee pays tax on the employer portion of the contribution. ²The Working Partner Premium amount is in addition to the employee contributions shown in the table above.

HMSA Bi-Weekly Employee Contributions for Dental and Vision Plans

View Contributions for Dental and Vision

Carrier Contact Info

(800) 776-4672
hmsa.com

Group: #94833
Hours: Mon-Sat 6 a.m. – 5 p.m. Pacific

Resources

2026 Summary Plan Description (SPD)

2027 Summary Plan Description (SPD)

2027 Health & Welfare Plans Summary - Hawaii

CVS Caremark Prescription Drug Lists and Pricing Tool

T-Mobile Benefits FAQ(opens in new tab)

LGBTQ+ Guide

Prescription Plans	Surest Copay Only	PPO Plan with Health Reimbursement Account (HRA Plan)	Exclusive Provider Organization (EPO Plan)	High Deductible Health Plan with Health Savings Account (HSA Plan)
Tier 1 (30 days)	$10 copay	10% ($5 copay min.-$20 copay max.)	$10 copay	Plan pays 80% after deductible
Tier 2 (30 days)	$75 copay	20% ($25 copay min.-$55 copay max.)	$35 copay	Plan pays 80% after deductible
Tier 3 (30 days)	$200 copay	30% ($45 copay min.-$80 copay max.)	$60 copay	Plan pays 80% after deductible
Mail Order/Retail (90 days)	2x monthly rate	2x monthly rate	2x monthly rate	Plan pays 80% after deductible
Preventive Medications	Subject to normal copay	Many are free	Subject to normal copay	Many are free
Weight loss Medications (anti-obesity and anorexiants)	2027: $100 copay max 2026: $55 copay max	2027: $100 copay max 2026: $55 copay max	2027: $100 copay max 2026: $55 copay max	Plan pays 80% after deductible
*The other differences are that in the HRA and HSA Plans, a robust list of preventive medications are FREE. You can review the covered preventive prescriptions and others, as well as costs at info.caremark.com/oe/t-mobile.

Coverage Election	Dental				Vision
	PPO Network		Open Network		Vision
	Employee	Employer	Employee	Employer	Employee	Employer
Employee Only	$6.00	$7.31	$17.00	$6.95	$3.50	$0.00
Employee plus Spouse	$12.00	$12.62	$31.00	$13.31	$6.00	$0.00
Employee plus Children	$14.00	$15.28	$37.00	$15.69	$6.00	$0.00
Employee plus Family	$20.00	$20.59	$52.00	$21.05	$9.50	$0.00
Domestic Partner¹	$6.00	$5.31	$14.00	$6.36	$2.50	$0.00
Domestic Partner Child¹	$8.00	$7.97	$20.00	$8.74	$2.50	$0.00
¹Domestic Partner deductions are taken on a post-tax basis, and employee pays tax on the employer portion of the contribution.

Coverage Election	Surest Copay Only Plan	PPO Plan with Health Reimbursement Account	Exclusive Provider Organization (EPO) Plan	High Deductible Health Plan with Health Savings Account (HSA)
Employee	$10.25	$52.88-$100	$108.39-$162	$44.97-$91
Employee + Spouse	$36	$121.28-$216	$232.28-$340	$105.45-$198
Employee + Children	$26	$104.12-$189	$202.64-$300	$90.21-$174
Employee + Family	$42	$163.05-$304	$336.39-$498	$137.53-$275
Additional Working Partner Premium	$46.15	$46.15	$46.15	$46.15

Coverage Election	Surest Copay Only Plan	PPO Plan with Health Reimbursement Account	Exclusive Provider Organization (EPO) Plan	High Deductible Health Plan with Health Savings Account (HSA)
Employee	$10.25	$48.62-$91	$98.57-$147	$41.50-$83
Employee + Spouse	$36	$112.75-$198	$212.65-$310	$98.50-$182
Employee + Children	$26	$96.31-$173	$184.97-$272	$83.78-$159
Employee + Family	$42	$150.94-$278	$306.94-$453	$127.97-$252
Additional Working Partner Premium	$46.15	$46.15	$46.15	$46.15
If you have a domestic partner or child of your domestic partner enrolled on the medical plan, the amount T-Mobile pays for your domestic partner/child of domestic partner coverage is added to your paycheck as taxable income because the IRS does not consider either to be a tax dependent. For additional information, please log in to your account at www.t-mobilebenefits.com/login.

Medical Plans	Surest Copay Only	PPO Plan with Health Reimbursement Account (HRA Plan)	High Deductible Health Plan with Health Savings Account (HSA Plan)	Exclusive Provider Organization (EPO Plan)
Calendar Year Deductible
Individual	$0	$2,250	$2,250	$750
Enrolled dependents	$0	$4,500	$4,500	$1,500
T-Mobile Account Funding (coverage on Jan 1)
Individual	N/A	$500*	$500**	N/A
Enrolled dependents	N/A	$1,000*	$1,000**	N/A
T-Mobile Account Funding (coverage Feb 1 or after)
Individual	N/A	$41.66/month*	$19.23/pay period**	N/A
Enrolled dependents	N/A	$83.33/month*	$38.46/pay period***	N/A
Out-of-Pocket Max (includes the deductibles)
Individual	$6,500	$4,250	$4,250	$3,750
Enrolled dependents	$13,000	$8,500	$8,500***	$7,500
Coinsurance (starts after deductible is met)	N/A	80% in-network, 60% out-of-network up to R&C	80% in-network, 60% out-of-network up to R&C	80% in-network only, NO coverage out-of-network
Office Visits
Preventive	FREE	FREE	FREE	FREE
In-person primary care physician (or a virtual care physician, if available)	$25-$130	$35	Deductible + coinsurance	$20
24/7 virtual medical care with a designated provider in the following networks: Premera Blue Cross enrollees: Doctor on Demand and 98point6 UHC enrollees: Teladoc, Optum Virtual Care, Walmart Health Virtual Care, Amwell, Doctor on Demand Surest enrollees: Amwell, Doctor on Demand, Alma, Talkspace	FREE	FREE	Deductible + coinsurance	FREE
In-person specialist	$25-$130	$50	Deductible + coinsurance	$30
In-person behavioral health visit with a licensed therapist	$25-$130	$35 (in or out of network)	Deductible + coinsurance	$20
Virtual behavioral health care with licensed psychiatrists or therapists in the following networks: Premera Blue Cross enrollees: Doctor on Demand and Talkspace UHC enrollees: Amwell, Doctor on Demand and Talkspace	$0-$130	$35	Deductible + coinsurance	$20
Emergency room	$600 copay	$200 copay, then 80% after deductible (copay waived if admitted)	80% after deductible	$200 copay, then 80% after deductible (copay waived if admitted)
To view cost estimate comparisons for how much you might spend out of pocket for certain services under each plan, click here. Entire T-Mobile funding is available first day of coverage. Any balance rolls over to the next year, up to $6,000 as long as you remain in the plan. T-Mobile contributions are prorated and funded by the Friday following each pay date. Any funds in your HSA are yours to keep, even if you leave T-Mobile. **The High Deductible Health Plan with HSA Plan features a true family deductible. The family deductible is two times the individual deductible and requires that the entire family deductible is met before paying 80% of covered charges. Please note that the out-of-pocket maximum works the same way.

Prescription Plans	Surest Copay Only	PPO Plan with Health Reimbursement Account (HRA Plan)	High Deductible Health Plan with Health Savings Account (HSA Plan)	Exclusive Provider Organization (EPO Plan)
Prescription Drugs
Tier 1 (30 days)	$10 copay	10% ($5 copay min.-$20 copay max.)	Plan pays 80% after deductible	$10 copay
Tier 2 (30 days)	$75 copay	20% ($25 copay min.-$55 copay max.)	Plan pays 80% after deductible	$35 copay
Tier 3 (30 days)	$200 copay	30% ($45 copay min.-$80 copay max.)	Plan pays 80% after deductible	$60 copay
Mail Order/Retail (90 days)	2x monthly rate	2x monthly rate	Plan pays 80% after deductible	2x monthly rate
Preventive Medications	Subject to normal copay	Many are free	Many are free	Subject to normal copay
Weight loss Medications (anti-obesity and anorexiants)	$55 copay max	$55 copay max	Plan pays 80% after deductible	$55 copay max
Preventive Prescription Drugs*
Tier 1 (30 days)	$10	FREE	FREE	$10
Tier 2 (30 days)	$75	FREE	FREE	$35
Tier 3 (30 days)	$200	FREE	FREE	$60
Mail Order/Retail (90 days)	Copay x 2	FREE	FREE	Copay x 2
Lifetime Maximum	n/a	Unlimited	Unlimited	Unlimited
*The other differences are that in the HRA and HSA Plans, a robust list of preventive medications are FREE. You can review the covered preventive prescriptions and others, as well as costs at info.caremark.com/oe/t-mobile.

Hawaii Medical Plans

Hawaii Medical Insurance

Provider Search

Hawaii Medical Plans at a Glance

HMSA Bi-Weekly Employee Contributions for Medical Plans

Plan Year: 01/01/2026 – 12/31/2026

HMSA Bi-Weekly Employee Contributions for Medical Plans

Plan Year: 01/01/2027 – 12/31/2027

HMSA Bi-Weekly Employee Contributions for Dental and Vision Plans

Resources

Money on the Table

Buffet of Services

Don't Wait for a Breakdown

The Umbrella Effect

Virtual Care Delivers

Surest

PPO with Health Reimbursement Account

High Deductible Health Plan with HSA

EPO Plan

Supplemental Health Plans

HMSA HMO and PPO:

HMSA Health Plan Hawaii Plus (HMO):

HMSA Preferred Provider Plan (PPO):

New Lyra Support for You and Your Family

Enhancements to all Aflac Plans

Enhanced Virtual Musculoskeletal Care Benefit

Enhanced Decision-Making Tool

Expanded Family-Building and Maternity Support

New LightCare Vision Benefit

Cost Per Pay Period Is Changing

Weight Loss Medication Cost Increase

Select Voluntary Benefits Now Available Through the Enrollment Experience

New Health Savings Account (HSA) Limits Are Increasing

Hawaii Medical Plan Changes