PAMCAH-UA Local 675 Health and Welfare Fund
HMSA Medical Plan
OptumRx Prescription Drug Plan
Plan Documents and SMMs
Forms and Notices
PAMCAH-UA Local 675 Health and Welfare Fund
The No Surprises Act protects you from balance billing if you get treated by an out-of-network provider from an in-network hospital or emergency room. Balance billing happens when an out-of-network provider charges you the difference between the total cost of your care and what your health plan agreed to pay.
The No Surprises Act is designed to ensure that you aren’t balance billed if you receive care under these circumstances. It protects you from paying extra when the circumstances are beyond your control.
You should still use network providers whenever possible. Visit your insurance carrier’s website to find a list of network providers near you (see below).
If you believe that you’ve been wrongly billed, contact the Employee Benefits Security Administration (EBSA) at 866-444-3272 or through their website.
The above summary is not a complete description of your rights under the No Surprises Act. For more detailed information about the No Surprises Act, read this notice.
Hawaii Medical Service Association (HMSA) Medical Plan
For more information or to find a provider, visit the HMSA website, or call
808-948-6079 or 800-776-4672 toll free.
The federal regulations require health plans and insurance carriers to disclose pricing information for certain items and services. The required information includes negotiated rates with in-network providers, as well as provider charges and amounts previously paid to out-of-network providers. The regulations require the information to be updated monthly. The information is contained in machine-readable files. These files can be opened in a spreadsheet program like Excel. They are huge files and not easy to use for the average person. HMSA is responsible for the information in the files and for keeping them up to date. You can access the files on HMSA’s website.
OptumRx Prescription Drug Plan
For more information or to find a network pharmacy, visit the OptumRx website, or call 844-265-1718.
Plan Documents
- SPD/Plan Document
- Health Plan Overview
- Full Benefit Summary of Benefits and Coverage (SBC)
- Abbreviated Benefit Summary of Benefits and Coverage (SBC)
Summaries of Material Modifications
- Applied Behavioral Analysis (ABA) Therapy Coverage Update (June 2024)
- Vision Care Benefits Update (June 2024)
- Vision Care Benefits Update (May 2024)
- Retiree Dental Benefit Update (January 2024)
- Speech Therapy Benefits Update (November 2023)
- Medicare-Eligible Retiree Benefit Update (October 2022)
- No Surprises Act SMM (October 2022)
- End of the COVID-19 Public Health Emergency SMM (April 2023)
- Humana Retiree Medicare-Eligible Benefit Changes SMM (October 2022)
- COVID-19 Test Coverage SMM (January 2022)
- Clarification Regarding Coverage of COVID-19 Testing SMM (September 2021)
- Delayed Lookback Period SMM (May 2021)
- COVID-19 Vaccine Coverage-Full Benefit SMM (March 2021)
- COVID-19 Vaccine Coverage-Abbreviated Benefit SMM (March 2021)
- Changes to Eligibility Rules SMM (November 2020)
- Maximum Period of Retiree Health Coverage Changes SMM (September 2020)
- Changes to Work Credit While Unemployed SMM (May 2020)
- COVID-19 Testing Benefit Changes SMM (March 2020)
- Hemophilia Medical Benefit SMM (January 2020)
Questions? Contact the Fund Office:
1109 Bethel Street, Room 403, Honolulu, HI 96813
Phone: 808-536-4408 Fax: 808-524-0658
Disclaimer
The above information highlights certain features of PAMCAH-UA Local 675 Health and Welfare Fund. Full details are contained in the Summary Plan Description and other documents that establish the Plan provisions. If there is a discrepancy between the wording here and the documents that establish the Plan, the document language will govern. The Trustees reserve the right to amend, modify, or terminate the Plan at any time.
While this website contains links to outside websites, this the Plan is not responsible for the accuracy or content of information contained on those sites. Those websites and services may have their own privacy policies and customer service policies, or no policy (policies) at all. We encourage you to review the privacy policies of any third-party websites or services. These links are offered for your convenience and do not constitute an endorsement of those websites. The inclusion of any such link does not imply a recommendation or endorsement by the Plan of the content and information on those websites.