HMSA Extra Benefits is a supplemental coverage plan that adds services beyond your base HMSA health insurance

HMSA Extra Benefits is an optional add-on to certain HMSA health plans in Hawaii. It covers services and items that your main plan does not pay for — things like dental work, vision care, hearing aids, and some wellness programs. You enroll in Extra Benefits separately from your base plan, and you pay an additional monthly premium for the coverage.

The specific services covered depend on which Extra Benefits package you choose. HMSA offers different tiers, and each one covers a different set of services at different cost-sharing levels. Some packages focus on dental and vision; others include hearing, chiropractic care, or acupuncture. You can add Extra Benefits when you first enroll in an HMSA plan, during the annual open enrollment period, or if you experience a may have access to life event like losing other coverage.

Key Takeaways

  • HMSA Extra Benefits is an optional add-on that covers services your base plan does not, such as dental, vision, hearing, and some wellness services.
  • You choose which Extra Benefits package to add based on what services matter most to you, and each package has its own monthly cost.
  • You can enroll in Extra Benefits when you first sign up for an HMSA plan, during annual open enrollment in November, or after a may have access to life event.
  • Coverage limits, copays, and deductibles vary by package, so comparing the tiers before you enroll helps you understand what you will actually pay.

What Services Extra Benefits Actually Covers

The most common Extra Benefits packages include dental coverage (cleanings, fillings, root canals, and crowns), vision coverage (eye exams, glasses, and contact lenses), and hearing coverage (hearing tests and hearing aids). Some packages also cover chiropractic visits, acupuncture, massage therapy, and other complementary services. A few packages include coverage for prescription eyeglasses or contact lenses beyond what the vision tier alone provides.

Each service has its own limits. For example, a dental package might cover two cleanings per year and pay 50 percent of the cost of a crown, but only up to a certain dollar amount. Vision coverage often includes one eye exam per year and an allowance toward frames and lenses — say, $150 every two years. Hearing coverage might pay for one hearing test per year and cover a portion of the cost of hearing aids, with a maximum benefit per ear.

The exact coverage details are in your plan documents, which HMSA provides when you enroll. It is worth reading the section on "covered services" and "benefit limits" for any package you are considering, because what sounds like full coverage may actually have a yearly maximum or a percentage you have to pay out of pocket.

How Much Extra Benefits Costs

The monthly premium for HMSA Extra Benefits varies based on which package you choose and your age. A basic dental-and-vision package might cost $20 to $40 per month for an individual, while a more comprehensive package that includes hearing, chiropractic, and other services could cost $60 to $100 or more. Family rates are higher and depend on how many family members you add.

In addition to the monthly premium, you will usually pay copays or coinsurance when you use a service. A dental cleaning might have a $15 copay, while a crown might require you to pay 50 percent of the cost after you meet a deductible. Vision exams often have a small copay, and the allowance toward glasses or contacts is separate from that copay.

HMSA publishes the exact rates and cost-sharing details in the plan summary documents available on their website or by calling their member services line. Rates can change each year, so if you already have Extra Benefits, you will receive updated information during open enrollment.

When and How to Enroll in Extra Benefits

You can enroll in HMSA Extra Benefits at three times: when you first sign up for an HMSA health plan, during the annual open enrollment period (usually November through December), or within 30 to 60 days of a may have access to life event. may have access to events include losing other health coverage, getting married, having a child, or moving to Hawaii.

To enroll, you contact HMSA directly by phone, through their website, or by mail. If you are enrolling when you first join an HMSA plan, you can add Extra Benefits at the same time. If you are adding it later, you will fill out a separate enrollment form and choose which package you want. The coverage usually starts on the first day of the month after HMSA receives your completed enrollment form.

If you miss the open enrollment window and do not have a may have access to life event, you will have to wait until the next open enrollment period to add Extra Benefits. Some employers offer Extra Benefits as part of their group plan, in which case you enroll through your employer's benefits system instead of directly with HMSA.

Extra Benefits vs. Paying Out of Pocket

Whether Extra Benefits makes financial sense depends on how often you use the services it covers. If you rarely go to the dentist or eye doctor, the monthly premium might cost more than you would spend paying out of pocket. But if you have regular dental work, need new glasses every year, or use hearing aids, the coverage can save you money.

A straightforward way to decide is to add up what you spent on dental, vision, and hearing care in the past year, then compare that to the annual cost of the Extra Benefits package (monthly premium times 12, plus any copays you would pay). If your past spending was higher than the annual cost, Extra Benefits probably saves you money. If it was lower, paying out of pocket might be cheaper.

Keep in mind that some services covered by Extra Benefits are not available through many dental or vision offices in Hawaii, or they cost significantly more without insurance. Hearing aids, for example, can cost $2,000 to $6,000 per pair without coverage, so even a package with a $1,500 yearly maximum can be worth the premium if you need them.

How to Use Extra Benefits Once You Are Enrolled

Once your Extra Benefits coverage starts, you use it by visiting a provider who accepts HMSA. For dental and vision, HMSA maintains a directory of in-network dentists and optometrists on their website. You can search by location or provider name. When you schedule an appointment, tell the office that you have HMSA Extra Benefits so they can verify your coverage and tell you what your copay or coinsurance will be.

At the time of your visit, you will present your HMSA member ID card (which includes your Extra Benefits information) and pay any copay due. The provider will bill HMSA for the rest. If you see an out-of-network provider, you will usually pay the full cost upfront and then submit a claim to HMSA for reimbursement — though reimbursement rates for out-of-network care are often lower than for in-network providers.

You can check your benefits online through the HMSA member portal, which shows your remaining deductible, how much of your yearly maximum you have used, and what services are covered. If you have questions about whether a specific service is covered, call HMSA member services before your appointment.

Changes to Extra Benefits During the Year

Once you enroll in an Extra Benefits package, your coverage stays the same until the end of the year unless you experience a may have access to life event. You cannot switch to a different package mid-year just because you want to — you have to wait for the next open enrollment period in November.

If you lose other coverage (such as dental insurance through a former employer), gain a dependent, or move out of Hawaii, you may be able to change your Extra Benefits package outside of open enrollment. You will need to provide proof of the life event to HMSA. If your life circumstances do not change, your Extra Benefits coverage renews automatically each January at the new rate for that year.

Frequently Asked Questions

Can I add Extra Benefits to an HMSA plan I already have?

Yes, if you are within 30 to 60 days of a may have access to life event or if it is during the annual open enrollment period in November and December. If neither applies, you will have to wait until the next open enrollment to add Extra Benefits. Contact HMSA to confirm whether your situation qualifies as a life event.

What happens if I do not use all my benefits before the year ends?

Most HMSA Extra Benefits do not roll over — if you do not use your yearly maximum or allowance, you lose it at the end of the year. The coverage resets on January 1. Some plans may have a short grace period, so check your plan documents or call HMSA to be sure.

Does Extra Benefits cover preventive services like cleanings and eye exams?

Yes, most Extra Benefits packages cover preventive dental care (cleanings and exams) and vision exams with little or no copay. However, the number of visits covered per year is limited — usually two cleanings and one eye exam annually. Anything beyond that limit may not be covered or may require you to pay out of pocket.

Can I use Extra Benefits if I am on Medicare?

HMSA Extra Benefits are designed for people with HMSA health plans, not for Medicare beneficiaries. If you are on Medicare, you would need to look into Medicare Advantage plans or separate dental and vision coverage designed for Medicare. Contact HMSA or Medicare directly to understand your options.

What if my dentist or eye doctor is not in the HMSA network?

You can still see an out-of-network provider, but you will pay more. You pay the full bill upfront and then submit a claim to HMSA for reimbursement. Out-of-network reimbursement is usually lower than what HMSA pays in-network providers, so you may end up paying a larger share of the cost yourself.