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Co-Pay Information

There are no co-pays or co-insurance for this plan, except for cost-sharing as described by your plan.

Members may have to share in the cost of health care services. This can happen if certain financial eligibility conditions are not met. Your assigned Hawai’i eligibility worker can help you find out your monthly cost-share amount. If you do have a cost-share amount, you will pay your provider each month. In most cases, this will be for long-term or community-based care. If you do not have a provider you will pay us directly.

You may have to pay for services. This can happen if:

QUEST Integration Non-Covered Services

Exceptions/Limits

Not Covered

Exceptions/Limits

Not covered when:
  • Performed solely for the purpose of rendering a member permanently incapable of reproducing
  • There is more than 1 purpose for performing the hysterectomy (but the primary purpose is to render the member permanently incapable of reproducing)
  • It is performed for the purpose of cancer prophylaxis

Exceptions/Limits

Not Covered

Exceptions/Limits

Not Covered

Exceptions/Limits

Non-covered services include:
  • Radiology services – ultrasounds for gender determination
Laboratory and diagnostic services:
  • Experimental
  • Investigational or generally unproven
  • IgG4 testing
  • Procedures related to storing, preparation and transfer of oocytes for in vitro fertilization

Exceptions/Limits

Non-covered services include:

  • Orthoptic training
  • Prescription fee, progress exams
  • Radial keratotomy, visual training and Lasik procedure
  • Contacts for cosmetic reasons

  • Cosmetic Procedures

    Exceptions/Limits

    Not Covered

  • Hysterectomies

    Exceptions/Limits

    Not covered when:
    • Performed solely for the purpose of rendering a member permanently incapable of reproducing
    • There is more than 1 purpose for performing the hysterectomy (but the primary purpose is to render the member permanently incapable of reproducing)
    • It is performed for the purpose of cancer prophylaxis

  • Investigational and Experimental Procedures

    Exceptions/Limits

    Not Covered

  • Medical Care in a Foreign Country for Children or Adults

    Exceptions/Limits

    Not Covered

  • Radiology, Laboratory,and Diagnostic Services

    Exceptions/Limits

    Non-covered services include:
    • Radiology services – ultrasounds for gender determination
    Laboratory and diagnostic services:
    • Experimental
    • Investigational or generally unproven
    • IgG4 testing
    • Procedures related to storing, preparation and transfer of oocytes for in vitro fertilization

  • Vision Services

    Exceptions/Limits

    Non-covered services include:

    • Orthoptic training
    • Prescription fee, progress exams
    • Radial keratotomy, visual training and Lasik procedure
    • Contacts for cosmetic reasons

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Last Updated On: 11/20/2015
‘Ohana Health Plan is committed to assisting members affected by the Kilauea Eruption. Read more. ×