Hawaii & Puerto Rico Medical Plan Options
Hawaii & Puerto Rico Medical Plan Options
Review the localized medical plan offerings and coverage details available for colleagues residing in Hawaii and Puerto Rico.
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| Plan Feature (In-Network) | HMSA PPO Hawaii Hawaii Regional PPO | Kaiser Permanente HMO Hawaii Hawaii Regional HMO | Triple-S PPO Puerto Rico Puerto Rico Regional PPO |
|---|---|---|---|
| Annual Deductible (Individual / Family) | $300 / $900 (Combined In/Out of Network) | $0 / $0 | $0 / $0 (Major Medical: $200 / $600) |
| Out-of-Pocket Maximum (Individual / Family) | $3,000 / $9,000 (Medical; Rx: $1,000 / $3,000) | $2,500 / $7,500 | $4,000 / $10,000 (Rx: $1,000 / $2,500) |
| Coinsurance (Plan pays after deductible) | 80% | 80% | 75% - 100% depending on service |
| Primary Care Visit | $17 copay / visit | $20 copay / visit | $10 copay / visit ($0 at SALUS Clinics) |
| Specialist Visit | $17 copay / visit | $20 copay / visit | $15 - $18 copay / visit ($0 at SALUS Clinics) |
| Urgent Care | $17 copay / visit | $20 copay / visit | $50 copay / visit (Emergency room tier) |
| Emergency Room | 20% after deductible | 20% coinsurance | $50 copay / visit |
| Generic Prescription (30-day supply) | $7.50 copay | $7.50 copay | $7.50 copay |
| Brand Prescription (Preferred Brand) | 20% coinsurance | 20% coinsurance | 20% coinsurance |
| Summary of Benefits & Coverage | HMSA PPO | Kaiser Permanente HMO | Triple-S PPO |
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