Your Guide to
Choosing a Medicare
Advantage Plan
Complete (PPO) &
Complete Plus (PPO)
2017 Summary of Benefits
and Sales Information
This is a summary of health services and
drug benefits by HMSA Akamai Advantage
Complete (PPO) and Complete Plus (PPO) from
January 1, 2017–December 31, 2017.
H3832_4001_2025_5865
WHAT’S INSIDE
About HMSA Akamai Advantage..................1
Why Choose HMSA Akamai Advantage?.....2
Travel Benefits.................................................3
Medications.....................................................4
Eligibility and Enrollment Dates....................5
Summary of Benefits......................................6
Choosing a Plan............................................ 11
Enrollment.....................................................12
Next Steps......................................................13
Important Information..................................14
Multi-Language Interpreter Services..........15
HMSA Centers and Offices............ Back cover
ABOUT HMSA AKAMAI ADVANTAGE
Stay in tune. Hit all the right notes with HMSA.
HMSA Akamai Advantage® is a Medicare Advantage prescription drug plan to help you live well. It has all the benefits of
Original Medicare and much more to help you be at your best
health and well-being.
Whether HMSA has been in your family for generations
or you’re coming to us for the first time, you’ve made the
right choice.
Since 1938, more people in Hawaii have chosen HMSA than
any other health plan. With more than 50 years of Medicare
experience, you have the peace of mind and security knowing
we’re here when you need us. And we’re here to help empower
you to take an active role in your health care.
1
WHY CHOOSE HMSA
AKAMAI ADVANTAGE?
With HMSA, you’ll have all the benefits of Original Medicare
and so much more.
Choose your doctors. You’ll have access
to 5,000 of the state’s best providers. With
primary care providers (PCPs), nurse
practitioners, and specialists, you’re sure
to find the care you need.
Financial protection. It makes dollars and
cents to choose HMSA. You’ll have a limit
on how much you pay for out-of-pocket
health care expenses. If you reach your
annual out-of-pocket maximum, we’ll
pay the rest of your Medicare-covered
expenses for the rest of the year.
Quick access to care. Speak to doctors
24/7 online or by phone without an
appointment with HMSA’s Online Care®.
You can also see a nurse or other health
care providers at your nearest walk-in
CVS/minuteclinic® at selected Longs
Drugs stores.
Online well-being tool. See where your well-being
is, find ways to improve it, and set goals when you
take the Gallup-Healthways Well-Being 5® survey.
Health education workshops. Attend a variety of
classes at no cost to learn how to sleep better, make
healthier food choices, stay physically active, and
more. Classes are held throughout the year at various locations. Check hmsa.com/well-being/workshops or our Island Scene magazine for a schedule
of classes.
Health coaching. Get guidance, support, and resources to help you manage chronic health conditions, stop smoking, relieve stress, and more.
Island Scene. Get tips on how to live well, recipes
for tasty dishes, health plan information, and more
with our quarterly magazine mailed to your home.
Read the magazine online, too, on our Well-Being
Hawaii blog at wellbeinghi.com.
Eye care benefits. Your health plan also
includes benefits for routine eye exams,
eye glasses, and contact lenses.
Fitness. Stay active with SilverSneakers® Fitness at
no cost. You’ll get membership to fitness centers at
more than 30 locations in Hawaii and 13,000 locations nationwide.
American Well® is an independent company providing
hosting and software services for HMSA’s Online Care
platform on behalf of HMSA.
Healthways, Inc.® is an independent company that provides wellbeing programs to engage members on behalf of HMSA.
Gallup-Healthways Well-Being 5®. All rights reserved.
2
TRAVEL BENEFITS
Wander the world. Visit new and familiar places with peace of mind.
We hope you never have to see a doctor while
traveling. But if you do, you can count on the
HMSA Akamai Advantage Visitor Travel Program.
34 U.S. states or Puerto Rico highlighted in
blue below, you may pay the same in-network
costs as if you were seeing a doctor in Hawaii.
As an HMSA Akamai Advantage member, you’ll
be part of the nationwide Blue Cross and Blue
Shield Association network. So if you need to
see a participating network doctor in one of the
Find a doctor or hospital in the state you’re
visiting. Call BlueCard at 1 (800) 810-BLUE
(2583) toll-free (printed on your HMSA membership card) or visit provider.bcbs.com.
HMSA Akamai Advantage Visitor Travel Program
Alabama, Arkansas, California, Colorado, Connecticut, Florida, Georgia, Idaho,
Illinois, Indiana, Kentucky, Maine, Massachusetts, Michigan, Missouri, Montana,
Nevada, New Hampshire, New Jersey,
New Mexico, New York, North Carolina,
Ohio, Oklahoma, Oregon, Pennsylvania,
Puerto Rico, South Carolina, Tennessee,
Texas, Utah, Virginia, Washington, West
Virginia, and Wisconsin.
For some of the states listed, MA PPO
networks are available only in portions of the
state. Learn more at hmsa.com/health-plans/
medicare/travel-program.
Worldwide coverage
Walk the Great Wall. Throw a coin in a Roman
fountain. Hike to Machu Picchu. See the world
with peace of mind knowing that your HMSA
membership travels with you. You’ll receive
benefits for doctor visits and hospital stays
just in case you have a medical emergency in
another country.
3
MEDICATIONS
Get affordable prescription drugs
at convenient locations.
Convenient mail-order service. Save time and
money when you have your maintenance
medications mailed to your home. Get a 90day supply for the price of a 30-day supply.
This is a great savings! And you’ll have a
constant supply of medication without interruption to help manage chronic conditions.
Affordable generic medication. Our prescription drug list includes generics to help you
get the medicines you need at an affordable
price. Generics are just as safe and effective as
brand-name drugs, but they cost less because
they don’t have the same marketing and research costs. You’ll get the same medication
for a lower price.
Local pharmacies. Most major retail pharmacy chains and many independent pharmacies
in Hawaii participate with HMSA, so you’re
sure to find one near you. Find pharmacies at
hmsa.com/advantage.
Pharmacy consultations. If you have questions
about your prescription medications, talk to
pharmacists on the phone or in person. They’ll
discuss your prescriptions with you, make
sure you understand how to take them, and
see if they work well with over-the-counter
drugs and supplements you may be taking.
To learn more, call CVS Caremark® at
1 (855) 479-3659, 24/7. For TTY, call 711.
While traveling. If you need a prescription
while you’re on the U.S. Mainland, just show
your HMSA membership card at any of the
68,000 CVS/caremark pharmacy locations nationwide. You can easily find pharmacies using
our provider directory and on hmsa.com.
CVS Caremark is HMSA’s pharmacy benefits manager.
CVS Caremark is an independent company.
4
ELIGIBILITY
Need help paying for
prescription drugs?
To enroll in HMSA Akamai Advantage,
you must:
• Have Medicare Part A (hospital insurance) and Part B (medical insurance).
• Continue to pay your Part B premium
in addition to your HMSA Akamai
Advantage premium.
• Not have end-stage renal disease
(ESRD). There are some exceptions.
Contact us for more information.
• Live in the City and County of Honolulu.
This applies to HMSA Akamai Advantage Complete (PPO) and Complete
Plus (PPO).
You could qualify for Extra Help through
Medicare. With Extra Help, Medicare could
pay up to 75 percent or more of your
prescription drug costs, including monthly
premiums, annual deductibles, and coinsurances without a coverage gap or late
enrollment penalty. To find out if you qualify,
contact:
• Medicare: 1 (800) MEDICARE
[1 (800) 633-4227] toll-free 24 hours a day,
seven days a week. For TTY, call
1 (877) 486-2048 toll-free.
• Social Security Administration:
1 (800) 772-1213 toll-free, Monday
through Friday, 7 a.m. to 7 p.m. TTY users,
call 1 (800) 325-0778 toll-free.
• The state Medicaid office:
1 (800) 316-8005 toll-free.
Still not sure if you’re eligible? Let us
know so we can help you. See our contact
information on the back of this brochure.
Apply for Extra Help at socialsecurity.gov/
medicare/prescriptionhelp.
ENROLLMENT
DATES
Important Dates to Remember
Annual Medicare Open Enrollment
Prescription drugs can be mailed to your home from the
HMSA Akamai Advantage mail-order pharmacy. Mail-order prescriptions are usually delivered within 14 days
after the pharmacy receives the order. If your drugs don’t
arrive within 14 days, please call 1 (855) 479-3659 tollfree, 24 hours a day, seven days a week; TTY users, call
1 (866) 236-1069 toll-free. Call these numbers if you want
to sign up for our optional automatic delivery program.
OCTOBER
DECEMBER
2016
2016
15
If you don’t join a Medicare prescription drug plan (Part D)
when you first become eligible and don’t have a prescription drug plan with benefits that are equal to or greater
than Medicare, you may have to pay a late enrollment
fee if you join a Part D plan later. If your income is above
a certain limit, you may pay an income-related monthly
adjustment in addition to your plan premium.
Your plan will start:
JANUARY
1
2017
5
7
SUMMARY OF BENEFITS
HMSA Akamai Advantage – Oahu
Choose a plan based on how many benefits and how much financial protection you want.
Your share of the cost:
$ = Copayment. A set dollar amount that you pay.
% = Coinsurance. The percentage of the cost that you pay.
Benefits
Complete
Complete Plus
YOU PAY
Monthly premium
You must continue to pay your Part B premium
in addition to your HMSA premium.
Annual deductible
What you’ll have to pay each year out-of-pocket
before the plan will pay for some services.
Maximum out-of-pocket
This financial safety net protects you from a
catastrophic illness or accident. It’s the most
you’ll pay out of pocket for Medicare-covered
services each year.
Inpatient hospital care*
Doctor’s office visits
• Primary care provider (PCP)
A physician or nurse practitioner who treats
common illnesses and manages your
preventive care.
• Specialist
A physician who treats specific conditions such
as allergies, heart disease, or foot disorders.
Preventive care
Includes annual wellness visits, bone mass
measurements, diabetes screenings, mammograms, and some vaccines such as flu shots,
hepatitis B shots, and pneumococcal shots.
For a complete list of preventive care services
that our plan covers, please see the Evidence
of Coverage.
$70
$158
$150 per year
for some services
(in-network and
out-of-network)
$6,700 per year (in-network)
$0
$3,400 per year (in-network)
$10,000 per year (in-network
and out-of-network)
$5,100 per year (in-network
and out-of-network)
In-network:
Days 1-6: $300/day
Days 7-60: $44/day
Days 61-90: $0/day
In-network:
Days 1-7: $280/day
Days 8-90: $0/day
Additional days: $0/day
Out-of-network:
Days 1-14: $375/day
Days 15-90: $0/day
Out-of-network:
Days 1-11: $375/day
Days 12-90: $0/day
Additional days: $0/day
$35 (in-network)
$15 (in-network)
30% of the cost (out-ofnetwork)
30% of the cost (out-ofnetwork)
$50 (in-network)
$30 (in-network)
30% of the cost (out-ofnetwork)
$0 (in-network and out-ofnetwork)
30% of the cost (out-ofnetwork
$0 (in-network and out-ofnetwork)
*For some services, your doctor or other network provider must request prior authorization.
Please contact us for more information.
6
SUMMARY OF BENEFITS (continued)
HMSA Akamai Advantage – Oahu
Benefits
Complete
Complete Plus
YOU PAY
Emergency care
You won’t pay a copayment for emergency
care if you’re admitted to the hospital
within 24 hours.
Urgent care
You won’t pay a copayment for urgent
care if you’re admitted to the hospital
within 24 hours.
Diagnostic services, labs, and imaging*
• Diagnostic tests and procedures, lab services, and outpatient X-rays
• Diagnostic radiology services, including
advanced imaging services such as MRI,
CT, and PET scans
• Therapeutic radiology services, such as
radiation treatment for cancer
Hearing services
Exam to diagnose and treat hearing and balance-related conditions. Doesn’t include routine
hearing exams or hearing aids.
Dental services
Limited dental services.
Doesn’t include services related to care, treatment, or filling, removing, or replacing teeth.
Vision services
• Exam to diagnose and treat eye diseases
and conditions
• Routine eye exam (once a calendar year)
$75
$75
$50
$30
20% of the cost (in-network)
20% of the cost (in-network)
30% of the cost (out-ofnetwork)
20% of the cost (in-network)
30% of the cost (out-ofnetwork)
$50 or 20% of the cost,
depending on the service (innetwork)
30% of the cost (out-ofnetwork)
20% of the cost (in-network)
30% of the cost (out-ofnetwork)
$50 (in-network)
30% of the cost (out-ofnetwork)
$50 (in-network)
30% of the cost (out-ofnetwork)
$30 (in-network)
30% of the cost (out-ofnetwork)
30% of the cost (out-ofnetwork)
$50 (in-network)
$30 (in-network)
30% of the cost (out-ofnetwork)
30% of the cost (out-ofnetwork)
$35 (in-network)
$15 (in-network)
30% of the cost (out-ofnetwork)
$35 (in-network)
30% of the cost (out-ofnetwork)
$15 (in-network)
30% of the cost (out-ofnetwork)
30% of the cost (out-ofnetwork)
*For some services, your doctor or other network provider must request prior authorization.
Please contact us for more information.
7
SUMMARY OF BENEFITS (continued)
HMSA Akamai Advantage – Oahu
Benefits
Complete
Complete Plus
YOU PAY
Vision services (continued)
• Contact lenses and eyeglasses (frames
and lenses)
The plan pays up to $100 every 24 months for
contact lenses and eyeglasses (frames and
lenses) from any provider.
• Eyeglasses or contact lenses after Medicare-covered cataract surgery
Mental health care
• Inpatient visit
Mental health care services that require a
hospital stay.
• Outpatient therapy visits
Individual and group visits
Skilled nursing facility*
Our plan covers up to 100 days in a skilled
nursing facility. No prior Medicare-covered
acute level of care hospital stay is required.
Outpatient rehabilitation*
• Cardiac (heart) rehab services (maximum
of two 1-hour sessions per day for up to 36
sessions up to 36 weeks)
• Occupational therapy, physical therapy,
and speech and language therapy visit
Ambulance
Transportation
$0 (in-network and out-ofnetwork)
$0 (in-network and out-ofnetwork)
$0 (in-network and out-ofnetwork)
$0 (in-network and out-ofnetwork)
In-network:
Days 1-20: $100/day
Days 21-90: $0/day
In-network:
Days 1-7: $250/day
Days 8-90: $0/day
Out-of-network:
Days 1-14: $375/day
Days 15-90: $0/day
$40 (in-network)
Out-of-network:
Days 1-11: $375/day
Days 12-90: $0/day
$30 (in-network)
30% of the cost (out-ofnetwork)
In-network:
Days 1-20: $0/day
Days 21-61: $164/day
Days 62-100: $0/day
30% of the cost (out-ofnetwork)
In-network:
Days 1-20: $20/day
Days 21-40: $155/day
Days 41-100: $0/day
Out-of-network:
Days 1-50: $200/day
Days 51-100: $0/day
Out-of-network:
Days 1-34: $150/day
Days 35-100: $0/day
$20 or $50 depending on the
service (in-network)
$20 or $30 depending on the
service (in-network)
30% of the cost (out-ofnetwork)
$40 (in-network)
30% of the cost (out-ofnetwork)
$40 (in-network)
30% of the cost (out-ofnetwork)
$200 (in-network and out-ofnetwork)
Not covered
30% of the cost (out-ofnetwork)
$200 (in-network and out-ofnetwork)
Not covered
*For some services, your doctor or other network provider must request prior authorization.
Please contact us for more information.
8
SUMMARY OF BENEFITS (continued)
HMSA Akamai Advantage – Oahu
Benefits
Complete
Complete Plus
YOU PAY
Foot (podiatry) care
Foot exams and treatment if you have
diabetes-related nerve damage and/or
meet certain conditions.
Medical equipment and supplies*
Includes oxygen tanks, walkers, and wheelchairs.
Fitness - Healthways SilverSneakers®
Fitness
Memberships to health clubs. To find locations
near you, call 1 (888) 423-4632, Monday–Friday,
3 a.m.–3 p.m. Hawaii time, or visit
silversneakers.com.
Medicare Part B drugs
Chemotherapy and other Part B drugs.
$50 (in-network)
$30 (in-network)
30% of the cost (out-ofnetwork)
30% of the cost (out-ofnetwork)
20% of the cost (in-network)
20% of the cost (in-network)
30% of the cost (out-ofnetwork)
$0
30% of the cost (out-ofnetwork
$0
20% of the cost (in-network)
20% of the cost (in-network)
30% of the cost (out-ofnetwork)
30% of the cost (out-ofnetwork)
$380
(Doesn’t apply to tier 1)
$0
$4.50
$12
$47
$100
25% of the cost
$4
$11
$45
$95
33% of the cost
$4.50
$12
$94
$200
25% of the cost
$4
$11
$90
$190
33% of the cost
PRESCRIPTION DRUGS
Annual deductible
What you’ll have to pay each year out-of-pocket
before the plan will pay.
Initial coverage stage
Until total drug costs reach $3,700.
30-day supply from retail pharmacies
-- Tier 1 – Preferred generic
-- Tier 2 – Generic
-- Tier 3 – Preferred brand
-- Tier 4 – Non-preferred drug
-- Tier 5 – Specialty
90-day supply from mail-order pharmacy
-- Tier 1 – Preferred generic
-- Tier 2 – Generic
-- Tier 3 – Preferred brand
-- Tier 4 – Non-preferred drug
-- Tier 5 – Specialty
SilverSneakers® is a registered trademark of Healthways, Inc.
All rights reserved.
Healthways, Inc.® is an independent company that provides
well-being programs to engage members on behalf of HMSA.
*For some services, your doctor or other network provider must request prior authorization.
Please contact us for more information.
9
SUMMARY OF BENEFITS (continued)
HMSA Akamai Advantage – Oahu
Benefits
Complete
Complete Plus
YOU PAY
PRESCRIPTION DRUGS (continued)
Coverage gap
40% of the plan’s cost for brand
40% of the plan’s cost for
Until your yearly out-of-pocket drug costs reach
drugs.
brand drugs.
$4,950.
51% of the plan’s cost for
51% of the plan’s cost for
generic drugs.
generic drugs.
Additional gap coverage for tier 1 drugs
• 30-day supply from retail pharmacies
Not covered
$4
• 90-day supply from mail-order pharmacy
Not covered
$4
Catastrophic coverage
The greater of 5% or $3.30 for The greater of 5% or $3.30 for
After your yearly out-of-pocket drug costs reach generic drugs (including brand generic drugs (including brand
$4,950.
drugs treated as generic) and drugs treated as generic) and
$8.25 for all other drugs.
$8.25 for all other drugs.
HMSA Akamai Advantage is a PPO plan with a
Medicare contract. Enrollment in HMSA Akamai
Advantage depends on contract renewal. The
benefit information provided is a brief summary, not a complete description of benefits. For
more information, contact the Plan. For benefit
details, refer to the Evidence of Coverage at
hmsa.com/advantage.
To learn more about the health plan benefits
and costs of Original Medicare, see the Medicare & You handbook at medicare.gov. To request a copy, call 1 (800) MEDICARE [1 (800)
633-4227]. For TTY, call 1 (877) 486-2048. Contact us if you’d like to receive a copy in Braille,
large print, audio, or other formats.
Limitations, copayments, and restrictions may
apply. Benefits, formulary, pharmacy network,
provider network, premium, and/or copayments/ coinsurance may change on January 1
of each year.
HMSA works closely with CVS Caremark
(Longs Drugs) to help get you the medications
you need. However, other pharmacies are
available in our network. You can see our
plan’s provider and pharmacy directory at
hmsa.com/advantage.
This plan helps you pay for Part D drugs and
Part B drugs, such as chemotherapy and some
drugs administered by your provider. See the
complete list of Part D prescription drugs and
any restrictions at hmsa.com/advantage.
Out-of-network/non-contracted providers are
under no obligation to treat HMSA Akamai
Advantage members except in emergency
situations. To find out if we’ll pay for an out-ofnetwork service, you or your provider can ask
us for a pre-service organization determination
before you receive the service. Please call us or
see your Evidence of Coverage for more information, including your cost for out-of-network
services.
10
CHOOSING A PLAN
When choosing a health plan, one size doesn’t fit all. And your health plan needs
can change. That’s why we give you a choice between two health plans – Complete
and Complete Plus. Each comes with different levels of benefits and costs.
So when choosing a
plan, consider more
than just costs.
Consider how much
health care services,
medications, and
financial protection
you need. Here’s a
guide to help you
decide.
What you pay
Complete
Complete Plus
Monthly premiums
Lower
Higher
Out-of-pocket costs
Copayments and coinsurance
Higher
Lower
Maximum out-of-pocket cost
Annual limit on how much you pay
Higher
Lower
Should I choose Complete or Complete Plus?
Complete
Complete Plus
Monthly premium: Lower.
Monthly premium: Higher.
Things to consider: Higher out-ofpocket costs when you see a doctor,
go to the hospital, get prescriptions,
and use other health care services.
Less financial protection if you have
a catastrophic accident or illness.
Things to consider: Lower out-ofpocket costs for health care services
and medications. More financial
protection if you have a catastrophic
accident or illness.
VS
This plan may be for you if: You
have chronic health conditions, see
doctors often, take a lot of medication, anticipate surgery, and have a
low risk tolerance.
This plan may be for you if: You’re in
relatively good health, don’t use a
lot of health care, need health insurance just in case, and have a high
risk tolerance.
Tip: Do you have a government retiree plan?
If you have a state or county retiree plan, talk to your health plan administrator at work before enrolling in HMSA Akamai Advantage. You may not need to
enroll in HMSA Akamai Advantage. Also, if you enroll in a Medicare Advantage
prescription drug plan, you may lose your retiree plan and may not be able to
re-enroll. If you have a federal plan, you may enroll in HMSA Akamai Advantage. However, keep in mind that you may still have out-of-pocket costs.
11
ENROLLMENT
Join today, enjoy tomorrow
Choose one of five easy ways to enroll.
Online. Enroll 24/7 during Medicare’s open
enrollment October 15–December 7 at
hmsa.com/advantage. Follow the instructions
to complete the online application. Once you
submit your request, you’ll receive a confirmation number.
Phone. Call an HMSA sales representative,
8 a.m.–8 p.m., seven days a week.
• Oahu: 948-6235
• Neighbor Islands: 1 (800) 693-4672 toll-free
• TTY: 711
In person. We’ll be happy to see you and help
you enroll. Visit your nearest HMSA Center or
office. (See back page for locations and hours.)
Mail. Fill out the HMSA Akamai Advantage
application and mail it to:
HMSA Akamai Advantage Sales
P.O. Box 3500
Honolulu, HI 96811-3500
Through Medicare. You can also enroll in
HMSA Akamai Advantage at medicare.gov.
12
NEXT STEPS
Keep playing. We’ll make your transition to HMSA
Akamai Advantage as smooth and easy as possible.
Here’s what you can expect from us:
Enrollment verification letter. After we receive your application, we’ll send
you a letter confirming your enrollment.
Welcome packet. You’ll receive an HMSA Akamai Advantage welcome
packet in the mail. Please read the information about your plan benefits. It
can help you get the best care and save money on health care.
HMSA membership card. You’ll receive your new card in the mail. Show
this card when you see your doctor or go to a hospital. Treat it like a credit
card. To prevent identity theft, don’t share your card with anyone and keep
it in a safe place. Cut up old or out-of-date cards.
Getting care. To get the most savings from your health plan, go to doctors, hospitals, pharmacies, and other providers in the HMSA Akamai
Advantage network. They have an agreement with HMSA to charge you a
lower amount than providers outside the network. You can go to providers
outside the network, but you may pay more.
13
IMPORTANT INFORMATION ABOUT YOUR
HEALTH PLAN
HMSA doesn’t discriminate
We comply with applicable federal civil rights laws. We don’t discriminate,
exclude people, or treat people differently because of:
• Race.
• Color.
• National origin.
• Age.
• Disability.
• Sex.
Services that HMSA provides
To better communicate with people who have disabilities or whose primary
language isn’t English, HMSA provides free services such as:
• Language services and translations.
• Text relay and sign language services.
• Information written in other languages.
• Information in other formats, such as large print, audio, and accessible
digital formats.
If you need these services, please call 1 (800) 660-4672 toll-free.
How to file a grievance or complaint
If you believe that we’ve failed to provide these services or discriminated in
another way, you can file a grievance in any of the following ways:
• Phone: 1 (800) 660-4672 toll-free
• Email: [email protected]
• Fax: (808) 948-6414
• Mail: 818 Keeaumoku St., Honolulu, HI 96814
You can also file a civil rights complaint with the U.S. Department of Health and
Human Services, Office for Civil Rights, in any of the following ways:
• Online: ocrportal.hhs.gov/ocr/portal/lobby.jsf
• Phone: 1 (800) 368-1019 toll-free; TDD users, call 1 (800) 537-7697 toll-free
• Mail: U.S. Department of Health and Human Services, 200 Independence Ave.
S.W., Room 509F, HHH Building, Washington, D.C. 20201
For complaint forms, please go to hhs.gov/ocr/office/file/index.html.
Source:
http://www.hhs.gov/civil-rights/for-individuals/section-1557/translated-resources
H3832_4036_2025_1157_v2 Accepted
14
MULTI-LANGUAGE INTERPRETER SERVICES
English
ATTENTION: If you speak a foreign language, language assistance services, free of charge, are
available to you. Call 1 (800) 660-4672 (TTY: 711).
Ilokano (Ilocano)
PAKDAAR: Nu saritaem ti Ilocano, ti serbisyo para ti baddang ti lengguahe nga awanan bayadna,
ket sidadaan para kenyam. Awagan ti 1 (800) 660-4672 (TTY: 711).
Tagalog (Tagalog – Filipino)
PAUNAWA: Kung nagsasalita ka ng Tagalog, maaari kang gumamit ng mga serbisyo ng tulong sa
wika nang walang bayad. Tumawag sa 1 (800) 660-4672 (TTY: 711).
日本語 (Japanese)
注意事項：日本語を話される場合、無料の言語支援をご利用いただけます。
1 (800) 660-4672 (TTY: 711)まで、お電話にてご連絡ください。
繁體中文 (Chinese)
注意：如果您使用繁體中文，您可以免費獲得語言援助服務。請致電
1 (800) 660-4672 (TTY:711)
한국어 (Korean)
주의: 한국어를 사용하시는 경우, 언어 지원 서비스를 무료로 이용하실 수 있습니다.
1 (800) 660-4672 (TTY: 711)번으로 전화해 주십시오.
Español (Spanish)
ATENCIÓN: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística.
Llame al 1 (800) 660-4672 (TTY: 711).
Tiếng Việt (Vietnamese)
CHÚ Ý: Nếu bạn nói Tiếng Việt, có các dịch vụ hỗ trợ ngôn ngữ miễn phí dành cho bạn. Gọi số
1 (800) 660-4672 (TTY: 711).
Gagana fa’a Sāmoa (Samoan)
MO LOU SILAFIA: Afai e te tautala Gagana fa’a Sāmoa, o loo iai auaunaga fesoasoan, e fai fua e
leai se totogi, mo oe, Telefoni mai: 1 (800) 660-4672 (TTY: 711).
Kajin Ṃajōḷ (Marshallese)
LALE: Ñe kwōj kōnono Kajin Ṃajōḷ, kwomaroñ bōk jerbal in jipañ ilo kajin ṇe aṃ ejjeḷọk wōṇāān.
Kaalọk 1 (800) 660-4672 (TTY: 711).
H3832_4036_2025_17 Accepted
15
Foosun Chuuk (Trukese)
MEI AUCHEA: Ika iei foosun fonuomw: Foosun Chuuk, iwe en mei tongeni omw kopwe angei
aninisin chiakku, ese kamo. Kori 1 (800) 660-4672 (TTY: 711).
Hoʻokomo ʻōlelo (Hawaiian)
E NĀNĀ MAI: Inā hoʻopuka ʻoe i ka ʻōlelo [hoʻokomo ʻōlelo], loaʻa ke kōkua manuahi iā ʻoe.
E kelepona iā 1 (800) 660-4672 (TTY: 711).
Lokaiahn Pohnpei (Pohnpeian)
Ni songen mwohmw ohte, komw pahn sohte anahne kawehwe mesen nting me koatoantoal kan
ahpw wasa me ntingie [Lokaiahn Pohnpei] komw kalangan oh ntingidieng ni lokaiahn Pohnpei.
Call 1 (800) 660-4672 (TTY: 711).
Bisaya (Bisayan)
ATENSYON: Kung nagsulti ka og Cebuano, aduna kay magamit nga mga serbisyo sa tabang sa
lengguwahe, nga walay bayad. Tawag sa 1 (800) 660-4672 (TTY: 711).
Tonga (Tongan)
FAKATOKANGA’I: Kapau ‘oku ke Lea-Fakatonga, ko e kau tokoni fakatonu lea ‘oku nau fai atu ha
tokoni ta’etotongi, pea teke lava ‘o ma’u ia. Telefoni mai 1 (800) 660-4672 (TTY: 711).
ພາສາລາວ (Lao)
ໂປດຊາບ: ຖ້າວ່າ ທ່ານເວົາ້ ພາສາ ລາວ, ການບໍລກ
ິ ານຊ່ວຍເຫຼອ
ື ດ້ານພາສາ, ໂດຍບໍເ່ ສັຽຄ່າ,
ແມ່ນມີພອ
້ ມໃຫ້ທາ່ ນ. ໂທຣ 1 (800) 660-4672 (TTY: 711).
16
HMSA’s mission is to
provide the people of Hawaii
access to a sustainable,
quality health care system that
improves the overall health and
well-being of our state.
HAWAI‘I MEDICAL SERVICE ASSOCIATION
hmsa.com/advantage
HMSA CENTERS
Visit one of our HMSA Centers with convenient evening and Saturday hours.
Honolulu, Oahu
HMSA Center | 818 Keeaumoku St.
Monday through Friday, 8 a.m.–6 p.m. | Saturday, 9 a.m.–2 p.m.
Pearl City, Oahu
Pearl City Gateway | 1132 Kuala St., Suite 400
Monday through Friday, 9 a.m.–7 p.m. | Saturday, 9 a.m.–2 p.m.
Hilo, Hawaii Island
Waiakea Center | 303A E. Makaala St.
Monday through Friday, 9 a.m.–7 p.m. | Saturday, 9 a.m.–2 p.m.
OFFICES
Visit your nearest HMSA office Monday through Friday, 8 a.m.–4 p.m.:
Kailua-Kona, Hawaii Island | 75-1029 Henry St., Suite 301
Kahului, Maui | 33 Lono Ave., Suite 350
Lihue, Kauai | 4366 Kukui Grove St., Suite 103
PHONE
From October 1 – February 14: Call seven days a week, 8 a.m. to 8 p.m.
From February 15 – September 30: Call Monday–Friday, 8 a.m. to 8 p.m.
Oahu: 948-6235
Neighbor Islands: 1 (800) 693-4672 toll-free
TTY: 711
(03) 2025-5865 9.16 LE