Frequently Asked Questions

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Welcome to UHA

What does UHA stand for?

University Health Alliance.

How did UHA get its name?

In 1996, a group of physician teachers at the University of Hawaii John A. Burns School of Medicine decided to make a difference. They created the University Health Alliance to bring a simpler, more caring approach to employee health insurance. Since then, UHA has grown to offer the largest physician network in Hawaii.

What do you mean by Better Health, Better Life?

We believe good health is one of the keys to living the best life possible. That’s why we were the first health insurer in Hawaii to provide 100% coverage for wellness and preventive medicine, including annual physical exams, seasonal flu vaccines and a variety of health screenings. Better health leads to a better life.

How easy is it to switch to UHA from HMSA?

It’s actually a straightforward process. Here are the details:
1. You get a quote from us.
2. You agree to the quote and pay the first premium.
3. You enroll your employees.
4. We send the member ID cards to each of your employees.
That’s all there is to it!

How long does it take to switch to UHA?

Once you apply, our proposal will come back to you within a week. Enrollment times vary based upon your review time and the number of people in your employ. Your member ID cards will arrive 5 to 10 days later. Check out our Timeline.

I saw that ad about nurse visits, does everybody get a nurse visit?

Not everybody needs a nurse visit. But when your condition is being managed due to complications or serious diagnosis we come by and offer our help and advice.

Do you offer Medicare products?

No, we don’t.

My rates keep going up at HMSA. Do your rates go up every year, too?

It is an unfortunate fact of life in the current healthcare industry that costs tend to increase from year to year. That said, we’ve done our best over the last several years to keep our rates as low as possible, even as factors out of our control — such as the cost of prescription drugs — have gone up.

Do you offer individual plans?

No. We offer business plans for companies of all sizes.

Do you offer an HMO plan?

No. All of our plans allow you to choose from our extensive list of providers. No insurance company in Hawaii has a larger provider network than UHA’s.

How financially secure is your company?

Very secure. We consistently maintain at least double the state-required amount of financial reserves.

HMSA gets approvals for procedures from a mainland company. Do you?

No, we don’t. All decisions on services requiring prior authorizations are made in-house, right here in Hawaii. This frequently results in shorter pre-authorization times.

What is your average approval time for prior authorizations?

All prior authorizations are done within two weeks. Online submissions take about a week, and urgent situations are handled within 72 hours.

What does [health insurance term] mean?

Here’s a partial list of some commonly used health coverage and medical terms.

Group Administrator Change & Group Administration

I am a new Human Resources (HR) person handling the medical benefits for my company. How do I add myself as an authorized Group Administrator?

To add or remove an authorized Group Administrator, please complete a Group Information Change Form and send it to UHA. Please note that the form must be signed by a company officer or a person who is already an authorized Group Administrator. You cannot add yourself unless you are a company officer. If you are interested in signing up for access to our online portal (for enrollment, bill view and/or bill pay services) please complete an Online Employer Access Authorization and Certification Form.

How do I update my group's billing address, mailing address, phone number, or email address?

Please fill out a Group Information Change Form. The form must be completed and signed by an authorized group administrator. Once complete, please fax to 1-877-222-3198 or email to UHA Employer Services or your Client Services representative for processing.

Eligibility: General

When am I allowed to enroll an employee?

You can enroll employees during any of the following Qualifying Events:

  • When a new employee is hired;
  • Your group’s annual open enrollment period;
  • When an employee becomes eligible for coverage (ex: an employee goes from part time to  full time status); or
  • When an employee loses coverage elsewhere.

Please note that enrollments & terminations must be received within 31 days of the qualifying event. Enrollments are always effective the first of a given month and terminations are always effective on the last day of a given month.

Enrollment forms can be faxed to 1-877-222-3198 or emailed to UHA Employer Services. You can also sign up for the Online Employer Services System and enroll members 24/7 on our safe and secure portal.

Detailed information about eligibility and qualifying events can be found in the Group Administrator Handbook.

How do I add an Eligible Dependent (employee's newborn child, adopted child/children, stepchild/children, newlywed spouse or civil union partner) to the plan?

To enroll an eligible dependent, please complete a Member Enrollment Form. The completed form and the appropriate documents should be submitted to UHA by the Group Administrator. Additions to your health plan must be enrolled within 31 days of births, adoption, marriage, or civil union.

For more information regarding Eligible Dependents, please refer to your Group Administrator Handbook.

Are there deadlines for submitting changes to the group?

Changes to the group’s benefits can be made each year during open enrollment. UHA will send a letter 60 days prior to your renewal date and changes are due at least 30 days prior to your group’s renewal date. Please refer to the Group Administrator Handbook.

How do I terminate coverage for an employee or their dependent(s)?

A member’s coverage can be terminated by using the Member Termination form. Employee eligibility under most medical benefits programs terminates on the last day of the month in which employment ends. Mid-month terminations or retroactive terminations will not be accepted.

I terminated an employee's coverage but now I need to reverse the cancellation. What do I do?

If you terminated an employee’s coverage by accident, or circumstances have changed and they should not be terminated, you can re-enroll them with no break in coverage if the termination date has not yet passed. The quickest way is to re-enroll them is through UHA’s Online Employer Services System or by sending in a completed Enrollment Form. If the termination date has already passed, please contact us at (808) 532- 4000, extension 299.

I enrolled an employee for next month but it turns out he/she will not be eligible. What do I do?

Please complete the Member Termination Form stating the termination date as the day before coverage is going to be effective and send an email to UHA Employer Services or via fax to 1-877-222- 3198 with an explanation.

Until what age does UHA cover dependent children?

UHA will cover all eligible dependent children up until their 26th birthday. If an employee’s dependent is certified as disabled, the dependent may continue coverage after UHA has reviewed and approved enrollment of a completed Disability Certification Form.

My employee is Medicare eligible and will be going onto a Medicare plan and terminating UHA coverage, but his/her or civil union partner spouse is not Medicare eligible yet. Can the spouse keep UHA coverage?

Unfortunately, if the employee is not enrolled with UHA, dependents cannot keep UHA coverage.

My employee (or their dependent) has become Medicare eligible. Is there anything we need to do?

If any of your members become eligible for Medicare, please have them visit the Medicare website for information. Generally, signing up for Medicare can help the member reduce their out-of-pocket costs for medical services, especially when travelling outside the state of Hawaii.

How does UHA handle COBRA enrollment and billing? Does UHA bill the COBRA member directly?

Please refer to our special COBRA Information section.

Our company offers or will be offering both UHA 3000 and UHA 600, and our open enrollment period is coming up. How does an employee switch plans?

If an employee wants to switch between plans at the time of open enrollment, you can submit the Member Change Form or make the change via the Online Employer Services System. If you are sending a PDF form please send it to UHA Employer Services or via fax to 1-877-222-3198. If you would like to conduct open enrollment sessions please make sure to contact your Client Services representative and we will be happy to assist. 

Eligibility: Member ID Cards

How long does it take to get a Member ID card?

Member ID cards are usually mailed within 5 business days after an enrollment or request for a card has been received.

How can an employee or their dependent(s) get a replacement Member ID card?

Your employee can:

  • contact Customer Services
  • or email UHA via our online form
  • or complete and fax a Member Identification Card Request Form

If they register for Online Member Services, they can print out a temporary ID card.

Will dependents receive Member ID cards?

Each subscriber (employee) is issued two UHA Member ID Cards. The cards list the name of the subscriber and each dependent’s name. Please see previous question, “How can an employee or their dependent(s) get a replacement Member ID card?” for information on how to order additional UHA Member ID cards.

Billing

I did not receive my billing statement. Why?

It could be either of the following reasons:

  • If your business moved recently, we may still have your old address in our system. Please contact your dedicated Client Services representative to update your mailing and physical address with UHA any time you have a demographic change. Group Information Change form
  • If you are registered for Online View Bill access, paper billing statements are not sent.

Why am I still getting billed for an employee I removed from coverage last month?

Because of the state’s Prepaid Health Care law, UHA bills for premiums in advance. For example, the January bill is generated and sent in December. Any changes you make after the bill is generated will not show up until your next bill. For example, if an employee leaves on December 15th and you terminate his coverage, he will still appear on your January bill because the bill was already generated. The credit will appear on your February bill that you receive in January. For further assistance, please contact UHA’s Billing Department at (808) 532-4000, extension 353.

What is the best way to send my premium payment to UHA?

There are several ways you can send your payment to us besides mailing it:

How can I find out if my payment was received?

You can check your group’s account status using UHA’s Online Employer Services System. The account balance is updated every 48 hours. You can also contact a billing representative at 808-532-4000 extension 353 to confirm whether your payment was received. Please have your group number, payment amount and check number ready. If you made a direct deposit for your payment, please have your receipt handy for reference.

Rates and Contract Administration

Some of my employees want drug, vision and/or dental coverage, but others just need medical. Is it possible to have more than one benefit option?

It is important that you are aware of the requirements of the Hawaii State Department of Labor. As of January 2014, Health Care Reform requires some employers to provide certain minimum benefits to all eligible employees. Please contact your Client Services representative or broker for more guidance.

Since the Hawaii state law only requires employers to contribute to the single medical premium, can I pass on the cost of the drug, vision and/or dental premiums to my employees?

We suggest contacting the Hawaii State Department of Labor for official clarification.

The Hawaii State Department of Labor said I need to have an HC-15 submitted to prove that we are in compliance. What do I do?

UHA submits a monthly report to the DOL for all new groups, reinstating groups, and terminated groups. If you have been asked to have an HC-15 submitted, you can contact your Client Services representative to check to ensure that your group was reported or to find out when your group will be reported to the DOL to verify your company’s active contract for medical insurance.

How do I request a Schedule A/Form 5500?

Contact your Client Services representative to request the document. Please be specific about the data period you are requesting and who UHA should send it to. A new request must be sent each year. Schedule A/Form 5500s will be made available at the earliest 120 days after the last day of the requested data period.

Does signing the Schedule of Benefits lock me into a 12-month contract? Do I have to wait until my renewal to terminate coverage?

Signing the Schedule of Benefits secures your rates and premiums for 12 months or the stated period of time. You may still terminate your contract before the 12 months are up, but there are some limitations and requirements. Please refer to Article 7 of your Standard Agreement for Group Health Plan for more details.

Online Employer Services

How do I sign up for online access? Are there limitations?

To sign up, please complete and submit an Online Agreement Authorization and Certification Form. The only limitation is that only one authorized user can have Full Access because “Full Access” includes Online Bill Pay.

How soon will I see the Enrollments, Terminations or Changes I made in Online Enrollment?

Online Enrollment takes two business days to reflect on the Online Enrollment site. For example:

  • Tuesday – Enrollment Request entered in Online Enrollment
  • Wednesday – Enrollment Request is submitted to UHA
  • Thursday – The Member will appear in your Online Enrollment account. (The site takes 24 hours to refresh)

I'm having difficulties logging into Online Enrollment/Online Billing. Who do I contact for assistance?

For assistance with logging into your Employer Portal, please call an Enrollment representative at (808) 532-4000, ext. 299.

Brokers

What do I need to get a quote?

In order to receive a quote, please submit a completed Employer Application & Certification Form along with a completed Census Form. The Census Form can also be submitted as an Excel file.

Requests can be sent to Client Services or via fax to 1-877-222-3198.

Benefit Coverage

Can I change between UHA benefit plans at any time?

Once you select a plan, you must remain in the plan until your group’s next open enrollment period. Open enrollment period occurs annually. See your company’s Human Resources Director for your open enrollment period.

Does UHA have any pre-existing condition clause?

Our benefit plans do not limit coverage for pre-existing conditions.

What do I do if I have a pre-existing condition and would like to continue my treatment plan?

If you are a new member to UHA and are currently on a treatment plan, have your physician contact Health Care Services to discuss a treatment program to ensure there is no lapse in your medical services at 808-532-4006.

Also, ask your Human Resources Director for a UHA Transition Coverage Questionnaire or access it on our Forms and Documents page, under the Employer Forms tab. Completing and submitting this form will ensure continuation of your care during the transition period.

Who is responsible for notifying UHA regarding hospital outpatient or inpatient services?

Participating physicians are responsible because they have the necessary information to complete the notifications, i.e., diagnosis and procedure codes. If you have elected to receive your care from a Non-Participating provider, you become primarily responsible for this prior notification to UHA.

Who do I notify if I have an urgent authorization request?

Contact Health Care Services at 808-532-4006.

My physician has referred me to a specialist on the mainland. May I receive coverage for these services?

Your physician must submit an Out-of-State Services Request Form at least 2 weeks in advance.

We advise that you do not make travel arrangements until the review is completed and you and your referring physician receive written confirmation from us that the service will be covered. Benefit coverage information will be provided only after the review is completed. Airfare and lodging are not covered benefits.

Contact Health Care Services with any questions at 808-532-4006. For more information, please view Receiving Care Outside of Hawaii.

I would like to get a second opinion from a mainland provider. Is it a covered benefit?

Providers outside of Hawaii are not contracted with UHA, therefore, non-participating provider benefits will apply. This means UHA will pay only up to our eligible charge for non-participating providers, which is based on our rate for similar services performed in Hawaii. You are responsible for the difference between UHA’s payment and the provider’s actual charge (“balance billing”), which can be substantial.

Members are encouraged to obtain their second opinion within the State of Hawaii, which is covered at 100% of the eligible charge. If you are considering out-of-state services, please contact Health Care Services to discuss your options at 808-532-4006.

Claim Reconsideration and Appeal

Can a claim be reconsidered?

Yes, claims can be reconsidered for a variety of reasons. Please contact Customer Services for assistance.

What if I am not satisfied with the decision of my reconsidered claim?

If you are not satisfied with our response to your concern, you may file a formal appeal. The appeal must be filed within one year of the date UHA informed you of the denial or limitation of the claim or coverage for any requested service. Appeals must be submitted in writing to:

UHA Appeals Coordinator
700 Bishop Street, Suite 300
Honolulu, HI 96813

Your appeal will be reviewed by staff not involved in the original decision (nor a subordinate to the original decision maker). If the appeal concerns a clinical matter, it will be reviewed by an independent licensed practitioner with appropriate expertise and experience. If we need additional information to complete our review, we will notify you and give you reasonable time to respond.

For more information, please view How to Initiate An Appeal.

The final decision will be made by the UHA Appeals Committee. You will be notified of the final decision within 60 days of receipt of your written appeal, or within 30 days if your appeal concerns a denial of a clinical matter.

Expedited Appeals

You may request an expedited appeal if the standard time (30 or 60 days, as set forth above) for completing an appeal would:

  • seriously jeopardize your life or health,
  • seriously jeopardize your ability to gain maximum functioning, or
  • subject you to severe pain that cannot be adequately managed without the care or treatment requested

You may make your request for expedited appeal by calling Health Care Services at 808-532-4006. If a health care provider with knowledge of your condition makes a request for an expedited appeal on your behalf, we do not require a written authorization from you.

Who can request an appeal?

You or your authorized representative may request an appeal. Those include:

  • any person you authorize to act on your behalf as long as you follow our procedures. This includes filling out a form with us
  • a court-appointed guardian or agent under a health care proxy
  • a person authorized by law to provide substituted consent for you or to make health care decisions on your behalf
  • a family member or your treating health care professional if you are unable to provide consent

To designate an authorized representative to act on your behalf with UHA, you must submit to UHA the Authorized Representative Form. This form must be completed and returned to UHA’s Appeals Coordinator before an appeal request can be considered.

What if I am still not satisfied with the final decision of my appeal?

If you are not satisfied with the final decision of the UHA Appeals Committee, you have the following external appeal rights:

If you disagree with an appeals decision regarding medical necessity, appropriateness, or experimental or investigational services, you may request external review of the decision by an Independent Review Organization (IRO) assigned by the State of Hawaii Insurance Commissioner. This request must be submitted in writing to:

Hawaii Insurance Division
Attn.: Health Insurance Branch – External
Appeals 335 Merchant Street, Room 213
Honolulu, HI 96813

Your request must include the following documents:

If you do not elect to request review by an IRO, or if you disagree with an appeal of any other decision, your options for external review vary depending on your plan. For more information, please view If You Disagree With Our Final Appeals Decision.

Participating vs. Non-participating

What is the difference between "participating" and "non-participating" providers?

Participating providers have a signed contract with UHA, and receive reimbursement of eligible charges directly from UHA. From a member perspective, only a co-payment, deductible, applicable state excise tax, co- insurance, and payment for non-covered items (if any) may be required at the time of service.

All other providers, without signed UHA contracts, are considered non-participating providers. Non-participating providers may collect their full charge(s) from the member at the time of service.

How can I find out if my healthcare provider is a participating provider?

Participating providers can be found in our Care Provider Search tool on the UHA website here.

UHA’s directories are subject to change. For verification of the most current provider participation status, call Customer Services at: 532-4000, Toll free: (800) 458-4600.

How do I get reimbursed for services received from a non-participating provider?

Members are responsible for the total amount billed, usually at the time of service. UHA will make payments for covered services directly to the subscriber of the plan. Reimbursements will be at the UHA eligible, non- participating benefit level. At our sole discretion, however, we will make payments directly to non-participating hospitals for inpatient services. Therefore, the member is responsible for the difference between the billed charges and the amount of UHA’s reimbursement, including any applicable co-payments, co-insurance, or deductible.

UHA will not accept invoices or receipts as claim forms for services rendered in the U.S.

*Standard claim forms are:

  • Inpatient/Outpatient facilities – UB-04 CMS-1450
  • Professional/Other services – CMS-1500 (08-05)
  • Prescription drugs – DAH 3PT-1000

How do I get reimbursed for emergency services received in a foreign country?

Traveling to a foreign country for the purpose of receiving services is not a covered benefit, even if referred by your physician. Only emergency medical services performed outside the U.S. will be covered if they meet appropriate criteria.

Claims for services rendered by a foreign provider must be fully translated to English and must contain:

  • Patient’s name
  • Patient’s date of birth
  • Diagnosis
  • Procedures done with dates of service and charges (listed separately)
  • Name and address of the provider of service
  • Name and address of the facility where services were rendered
  • Your receipt of payment made, converted to U.S. Dollars and the rate of exchange on the dates of service

In certain instances, we may require additional documentation such as admission and discharge summaries, or daily hospital records.

If I should become injured or ill while traveling within the U.S., will my medical care be covered?

Yes. If you become injured or ill while traveling within the U.S., any emergency care, urgent care, or hospitalization will be covered according to your plan benefits. Through our relationship with UnitedHealthcare, you have access to UnitedHealthcare’s Options PPO Network, and seeing a UnitedHealthcare participating provider can significantly limit your out-of-pocket expenses. We recommend checking to see if there is a UnitedHealthcare participating provider in the area of travel.

Treatment for a condition which occurred or was diagnosed before your trip will be subject to the same prior authorization requirements as any non-emergent treatment outside of the State of Hawaii. Contact Health Care Services with any questions.

If I am attending college, working, or living on the mainland, or on COBRA, how do I facilitate my medical care?

Notify Employer Services regarding your out-of-state address.

You also have access to UnitedHealthcare’s Options PPO Network, a mainland network of providers, and one of the nation’s largest and most respected national PPO networks. Selecting a UnitedHealthcare participating provider is a benefit to you and provides a significant cost saving over a non-participating provider.

Enrollment

Who is considered a dependent?

The following are considered eligible dependents:

  • The spouse or Civil Union Partner of the employee
  • Dependent children up to age 26 regardless of marital status, enrollment in school, or residency
    Please note: Spouses and children of adult dependents do not qualify for this coverage
  • Unmarried children who are disabled and have a verifiable disability
  • Other categories of dependents are subject to the provisions of the employer’s Group Service Agreement. Please consult with your employer for questions about dependent eligibility.

How do I add my newborn child, adopted child, newlywed spouse or Civil Union Partner to my plan?

To enroll your newborn child, adopted child, newlywed spouse or Civil Union Partner, complete a Member Enrollment form. The form along with the appropriate documents should be submitted by the group administrator to UHA. Additions to your health plan must be enrolled within 31 days of birth, adoption, marriage, or civil union.

How do I add a new employee to our group?

An employer can add a new employee any time with the Member Enrollment form within 31 days of the date the employee becomes eligible for coverage. Coverage will always be effective on the first day of the month following enrollment.

How do I terminate coverage for an employee?

An employer can terminate an employee’s coverage by using the Member Termination form. Employee eligibility under most medical benefits programs terminates on the last day of the month in which employment ends. Mid-month terminations or retroactive terminations will not be accepted.

I lost my member ID card. How do I get a new one?

You may either contact Customer Services, email us via our online form, complete and fax a Request for Member Identification Card form or visit our Member Portal where you can register and print a temporary card.

How long does it take to get a member ID card?

Member ID cards are usually mailed within five to seven business days after an enrollment or request for a card is received.

Will my dependents receive member ID cards?

The subscriber will receive two ID cards. The cards list the name of the subscriber (employee) and each dependent’s name. Additional ID cards can be requested through Customer Services at 808-532-4000.

Out of State Coverage and U.S. Mainland Provider Network*

Why did UHA move from First Health Network (FHN) to UnitedHealthcare's Options PPO Network?

UnitedHealthcare has a more extensive U.S. mainland network than our previous partner. We believe this is a significant enhancement that will provide our members with greater peace of mind while away from home.

What enhancements can members expect from UnitedHealthcare’s Options PPO Network vs. First Health Network?

UHA’s primary service area and provider network remains in Hawaii where the best care for your needs is likely to be right here at home. However, when you or your ‘ohana do travel away from Hawaii to temporarily visit the U.S. mainland—whether that’s for study, travel or work—UHA has our members covered for emergency medical care.

Through our relationship with UnitedHealthcare, UHA will offer access to quality medical care from UnitedHealthcare’s extensive U.S. mainland network of providers, as well as online tools and resources to help members find the right care during their travels.

Does the UnitedHealthcare (UHC) network include international healthcare coverage and benefits?

No. Through the UHA Health Insurance benefit plan, members have access to the UnitedHealthcare Options PPO Network, which is available only on the U.S. mainland.

When can UHA members start utilizing providers in the UnitedHealthcare network assuming the services meet the criteria for payment network?

Starting May 15, 2021, UHA began offering the UnitedHealthcare Options PPO Network to our members. The date of service for the provider in the UnitedHealthcare network visit/service rendered (outside of Hawaii) must be no earlier than May 15, 2021 to be payable at participating benefit level under UHA (assuming the services received meet UHA’s criteria for payment).

How do members find a provider in the UnitedHealthcare network when on the mainland?

Use the UnitedHealthcare online provider directory at UHAHealth.com/mainlandnetwork.

By using UnitedHealthcare’s mainland provider network, our members will have access to quality health care resources to support all of their health-related needs while on the U.S. mainland.

Note: when at home in Hawaii, members utilize the UHA provider network. To find a convenient provider in Hawaii, go to UHAhealth.com and click on Find Care Providers & Drugs at the top of the screen or call Health Care Services at 808-532-4006 for assistance locating a provider who is accepting new patients.

How do Complementary and Alternative Medicine (CAM) benefits and services work under the UnitedHealthcare network?

UHA will follow UnitedHealthcare’s network for Chiropractor, Therapeutic Massage Therapy and Acupuncture services. If a provider is participating within the UnitedHealthcare network, the CAM benefits will be covered assuming the services meet UHA’s criteria for payment.

Where is the UnitedHealthcare provider directory located?

Visit UHAHealth.com/mainlandnetwork. Simply search the UnitedHealthcare online provider directory and locate a doctor or facility when on the U.S. mainland.

We created that dedicated online page for members to access UnitedHealthcare’s extensive provider network and quality health care resources to support all their health-related needs while away from home in the event of an emergency or if a dependent is living on the mainland for school.

*Insurance coverage is provided by UHA Health Insurance. The administrative services are provided by United HealthCare Services, Inc.

Express Scripts: General

How does Express Scripts help me manage my medications?

With Express Scripts you have access to pharmacists who have expertise in the medications for high blood pressure, asthma, diabetes or cancer. Pharmacists at Express Scripts can help with questions about your medications. The pharmacists can also advise you how to potentially reduce your medication costs.

When you log into your Member Portal at UHA, either on the website or the mobile site, you can also access your current prescription information with Express Scripts. You may also log in directly to Express Scripts at express-scripts.com or by calling the number listed below.

  • Customers calling about their prescriptions: 855-891-7978
  • Pharmacists (for Rx or PA information): 800-922-1557 or 800-753-2851
  • Providers (for PA): Express PAth

Your doctor can call in a prescription over the phone or enter the information on the website. In most cases, your doctor will get a real-time response.

Do I have to call Express Scripts, or can I call UHA's customer service line?

It is best to contact Express Scripts directly with questions about your copay or out of pocket costs. UHA’s phone lines are also available 8 am to 4 pm, Monday – Friday, except for major holidays. A representative can be reached at 808-532-4000 (or 800-458-4600 from the neighbor islands) at the extensions below:

  • Customer Services: or 800-753-2851 ext. 297
  • Health Care Services: ext. 300
  • Employer Services: ext. 299
  • Premium Billing: ext. 353

Express Scripts: ID Card

How do I get a new or replacement member ID card?

Should you misplace or not receive a new card, you may submit a request via our website or call our Customer Services department at 808-532-4000 or 1-800-458-4600 (from the neighbor islands). Your card will have the following information that your pharmacy needs to process your prescription(s):

RxBin: 003858
RxPCN: A4
RxGroup: NKTA

Please note that your drug plan may be self-insured by your employer or you may not have a drug benefit.

Do I need to show my member ID card at the pharmacy?

Yes. This is very important in order to avoid delays in processing extended or autofill prescriptions, as the pharmacy may not update the information until the member receives a rejection. The key is to give your pharmacist these numbers:

RxBin: 003858
RxPCN: A4
RxGroup: NKTA

These are the same for everyone with UHA drug coverage.

Reimbursement

How do I submit my receipts for prescriptions that I paid for out of pocket?

You may submit your receipts by fax directly to Express Scripts at 877-329-3760. There is a direct member reimbursement form (DMR) located on the Express Scripts website that you may send with your receipts that will ensure timely reimbursement (submit receipts within 90 days from date of purchase).

How do I file a Drug Claim from a Non-Participating Provider?

Non-participating pharmacies may require you to pay for your prescription in full and have you file your claim with UHA. You can submit your receipts for reimbursement via fax to Express Scripts at 877-329-3760. There is a direct member reimbursement form (DMR) located on the Express Scripts website that you may send with your receipts that will ensure timely reimbursement. You should note that the reimbursement is likely to be less than if you used a participating pharmacy.

Expres Scripts: Home Delivery

How does extended fill or mail order work?

UHA members may obtain an extended supply of their maintenance medications at most UHA-participating retail pharmacies within the Express Scripts network.

For mail order services, members may enroll in Express Scripts Home Delivery. Manage your prescription orders via a single login using your UHA Online Member Services account. Call 800.282.2881 to contact Express Scripts’ Patient Customer Service if you need help enrolling. Learn more on our Prescription Drugs page.

Express Scripts: Benefits and Coverage

How do I get vaccinations?

You can either get vaccinations at your doctor’s office or at a pharmacy in network.

Why do some drugs need prior authorization (PA)?

If a pharmacist tells you that your prescription needs a PA, your doctor should contact Express Scripts to be sure that drug is right for you. We also need to check if your plan covers the drug. This is similar to when your healthcare plan authorizes a medical procedure in advance.

When a prescription requires a PA, your doctor can call Express Scripts or prescribe a different drug that is covered by the plan. Only doctors can give Express Scripts the information they need to see if the drug is covered. Express Scripts answers PA phone lines 24 hours a day, seven days a week. A decision can be made right away. If the drug is covered, you will pay your normal copayment. If you choose the medication that is not covered, you will pay the full price.

How do I request a rush review?

Your doctor can use ExpressPAth online or submit a PA by phone. In most cases your doctor will receive a real-time answer. If approved, you will be able to pick up your medication right away.

What if I disagree with a decision made by Express Scripts?

If you disagree with a decision made by Express Scripts, your doctor may contact UHA’s Health Care Services department Monday-Friday, 8am to 4pm HST to request a peer-to-peer conversation within 30 days of the denial. We will arrange a time for your doctor to speak with our Medical Director or Chief Medical Officer. If you or your doctor would like to submit a written appeal, please follow our appeals process here.

Some drugs are managed under your medical benefits rather than by your pharmacy benefits. Some injectable drugs are reviewed by CareContinuUm, an Express Scripts company. If you disagree with a decision made by CareContinuUm, please contact them at (866) 877-7042, Monday-Friday, 8am to 5pm EST. With CareContinuUm, your doctor will be able to request a peer-to-peer conversation or submit a written appeal.

How will UHA cover my medications if I also have other insurance coverage?

COB (coordination of benefits) claims may be subject to PA, which means if the drug or procedure needs a PA from UHA, even if UHA is the secondary insurer, the PA will still need to be submitted.

Primary insurance coverage applies to the original claim, but the member is responsible for the remaining balance. That amount will come in on a claim to UHA as the secondary insurer. Some examples are listed below:

Note: Primary insurance already paid on the claim, so the COB claim comes to UHA as secondary insurance.

Example #1 $30 patient responsibility

  • $0 deductible
  • $45 UHA Drug Plan
UHA pays $0
Member pays $30
Example #2 $30 patient responsibility

  • $0 deductible
  • $15 Drug Plan copay
UHA pays $15
Member pays $15
Example #3 $500 patient responsibility

  • $0 deductible
  • $15 Drug Plan copay
UHA pays $485
Member pays $15
Example #4 $500 patient responsibility

  • $0 deductible
  • $100 Drug Plan co-insurance
    (20% 4th tier)
UHA pays $400
Member pays $100

Plans P, & S have $200 & $250 drug price limits respectively, which means the coinsurance will hit the “4th Tier 20% coinsurance requirement” if the drugs exceed those amounts.

Definitions

I don't understand the difference between Generic, Preferred Brand and Non-Preferred Brand drugs. Please explain.

  • Generic drugs are the lowest cost drugs; copies of patented Brand name drugs that have the same chemical action as Brand name drugs.
  • Brand medications are either Preferred or Non-Preferred (sometimes referred to as Formulary or Non-Formulary).
  • Preferred Brand drugs have a lower copay than Non-Preferred Brand drugs.
  • Non-Preferred Brand drugs are newer drugs that are usually the most expensive drugs available among them all.

Can you explain what Step Therapy is?

Step therapy is for people who take prescription drugs daily to treat a long-term condition (arthritis, asthma, or high blood pressure). It lets you get treatment at a lower cost. It also helps your employer maintain prescription drug coverage for everyone your plan covers.

In step therapy, medicines are grouped in categories based on treatment and cost.

  • First-line medicines are the first step. They are generic and lower-cost brand-name drugs approved by the U.S. Food & Drug Administration (FDA). They are proven safe, effective and affordable. Step therapy suggests you try these drugs first. In most cases they provide the same health benefits as more expensive drugs, but at a lower cost.
  • Second-line drugs are the second and third steps. These are often brand-name drugs. They are best for patients who don’t respond to first-line drugs. Second-line drugs are the most expensive.

Generic drugs have the same chemicals as the brand-name. They also have the same effect. Though generics may have a different name, color and/or shape, they have been through the same testing as the original drug. They have also been approved by the FDA as safe and effective in the same manner as the original drug.

Unlike manufacturers of brand-name drugs, the companies that make generic drugs don’t spend as much money on research and advertising. As a result, generic drugs cost less than the original brand-name drug and the savings get passed on to you.

The first time you try to fill a prescription that isn’t for a first-line medicine, your pharmacist should explain that step therapy asks you to try a first-line medicine before a second-line drug. Only your doctor can change your current prescription to a first-line drug covered by your plan.

Can you explain what Quantity Limits are?

Quantity limits make sure that you get the right amount of medication and in the least wasteful way. For example, your doctor might have told you to take two 20mg pills each day. If that medication was also available in 40mg pills, our staff would ask the doctor to prescribe one 40mg pill a day instead of two 20mg pills. In addition, if the doctor wrote the original prescription for 30 pills (a 15-day supply), the new prescription for 30 pills would last a full month — resulting in just one copayment, not two.

If the prescription is for a larger quantity, the pharmacist can fill the prescription for the amount that the plan covers or contact the doctor to discuss other options. The pharmacist may increase the strength or get a PA for the quantity originally prescribed.

General

How do I add a physician to our practice?

Complete a Participating Provider Add Form and submit copies of the new physician’s Hawaii State and Federal DEA licenses (if applicable). Please include the provider group’s TIN (Tax ID Number) and NPI (National Provider Identifier) number(s).

Can I receive my reimbursements with an automatic deposit?

Yes. See the section on Electronic Funds Transfer (EFT).

How do I change my billing address?

Complete the Existing Provider Change form to report changes in billing address.

How often is the provider/physician fee schedule revised?

The provider/physician fee schedule is updated every two years, based on the prior year’s Medicare rates.

How do I report a change in company name and/or Federal Tax ID number?

Complete the Existing Provider Change form to report changes in company name and/or Federal Tax ID number, along with an updated W-9 form. If both have changed, please contact Customer Services as you may have to sign a new Provider Agreement.

My current Provider Identification Number (PIN) is my social security number. Can that be changed?

Yes. Send a request in writing and we will send you a new unique PIN number. Submit your request to:

UHA Contracting Services
700 Bishop Street, Suite 300
Honolulu, HI 96813-4100

Toll free fax: (866) 572-4383
Email: [email protected]

What is the patient co-pay for a physician office visit?

The patient’s UHA plan is listed on the member ID card. Currently the co-payments are:

UHA 3000 (Bundle): $12*
UHA 600 (Bundle): 10% of the eligible charge*

*Tax on the physician office visit charge is not a covered benefit. The provider is responsible for calculating the tax portion based on the eligible charge. Co-payment amounts are subject to change without notice.

Am I able to check claim status or claim payments online?

Online Claim status is now offered via Online Provider Services. For more information contact Customer Services at (808) 532-4000, or toll free at 1-800-458-4600 from the Neighbor Islands.

Are EDI claims submissions accepted?

Yes. There are two ways to submit EDI claim submissions. A connection can be made directly to UHA as an 837 transaction or through the Hawaii Xchange online service. Click here to read more about each submission method.

What is the procedure for submitting a claim, where Medicare is primary and UHA is secondary?

Submit the Medicare Explanation of Benefit along with the claim form to UHA.

Claim Reconsideration and Appeal

How do claims get paid based on billed charges?

Refer to the diagram below. Please contact Customer Services if you need further assistance.

Can a claim be reconsidered?

Yes, claims can be reconsidered for a variety of reasons. Please contact Customer Services for assistance.

What if I am still not satisfied with the final decision of my reconsidered claim?

If you are not satisfied with our response to your concern, you may file a formal appeal. The appeal must be filed within one year of the date UHA informed you of the denial you wish to appeal. Appeals must be submitted in writing to:

UHA Appeals Coordinator
700 Bishop Street, Suite 300
Honolulu, HI 96813

Your appeal will be reviewed by staff not involved in the original decision (nor a subordinate to the original decision maker). If the appeal concerns a clinical matter, it will be reviewed by an independent licensed practitioner with appropriate expertise and experience. If we need additional information to complete our review, we will notify you and give you reasonable time to respond.

For more information, please view our Provider Handbook.

The final decision will be made by the UHA Appeals Committee. You will be notified of the final decision within 60 days of receipt of your written appeal, or within 30 days if your appeal concerns a denial of a clinical matter.

Expedited Appeals
You may request an Expedited Appeal if the standard time (30 or 60 days, as set forth above) for completing an appeal would:

  • seriously jeopardize the member’s life or health;
  • seriously jeopardize the member’s ability to gain maximum functioning; or
  • subject the member to severe pain that cannot be adequately managed without the care or treatment requested.

To request an Expedited Appeal, call Health Care Services.

What if I am still not satisfied with the final decision of my appeal?

If you wish to contest our decision on any appeal, you must agree to binding arbitration. To request binding arbitration, you must submit a written request for arbitration to UHA within 60 days of the date of the letter communicating the decision of the Appeals Committee. Both parties will agree on the person to serve as the independent arbitrator. The decision of the arbitrator is binding on both parties. Costs for the arbitration will be shared as ordered by the arbitrator. Further details are provided in your Participating Provider Agreement.

Referrals and Authorizations

How do I refer a patient to a participating specialist?

Primary care physicians (PCP) and other participating specialists may direct members to any participating specialist. A formal referral is not necessary.

How do I refer a patient to a non-participating specialist?

Complete the Request for Authorization form or contact Health Care Services to discuss the referral.

Can another primary care provider (PCP) see my patient?

Yes. In order to meet the needs of our members, our plans allow for this kind of flexibility.

Is prior authorization required for mental health outpatient visits?

No.

Who is responsible for prior authorization for procedures performed by a specialist?

The specialist that will be performing the procedure is responsible for obtaining authorization by completing a Request for Authorization form. The primary care physician (PCP) should also be notified.

How are approved requests for authorization confirmed?

Providers who have registered for Online Provider Services* may view the status of authorization requests online. Otherwise, approved requests are confirmed in writing and delivered either by mail or fax. You must receive more than verbal notification for non-emergency care.

* For more information about Online Provider Services, please click here.

How long does it take to get an authorization approved?

We ask that you submit your prior authorization well in advance of the service date(s), allowing two weeks (15 days) for a determination to be made.

May I submit an expedited request for prior authorization?

You may, but be aware that expedited requests are defined as those which may seriously jeopardize life or health, or the ability to regain maximum functioning.

May I submit a request for authorization after a procedure has been performed?

Not typically, but requests will be handled on a case-by-case basis. Complete a Request for Authorization form and submit it for consideration.

Preventing Returned / Denied Claims

Tip #1: How to Avoid Returned Claims

Reduce the time it takes to process your claim and avoid a returned claim by completely and correctly filling in the claim form.

The following items, if missing or incorrect, will delay processing of your claim or even result in a request for re-submission:

  • Subscriber’s name
  • Subscriber’s member ID number (11-digits)
  • Patient’s name and date of birth
  • Date of service
  • UHA group number (4-digits)
  • Name of referring physician for claims from laboratories, radiologists, and consultants
  • Date, place, and cause of injury
  • Descriptive diagnosis and ICD-9 code
  • Descriptive procedures and CPT code
  • Charges
  • Provider’s billing name and address
  • Provider or agent’s signature
  • Supportive data for modifiers, e.g. after-hours modifier – claim should have time listed
  • Provider Identification Number (PIN)
  • Federal tax ID number

Tip #2: Coding Corner

Avoid the following possible claims(s) denials:

  • Claim submitted with Modifier -25 or -57?*
    • Tip: Submit your claims with supporting documentation indicating a significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service.
  • Claim submitted with Modifier -59?*
    • Tip: Submit your claim with supporting documentation indicating the service was distinct or independent from other service(s) performed on the same day.
  • Claim submitted with duplicate CPT codes?*
    • Tip: Submit your claim with supporting documentation indicating the service(s) is not a duplicate.
  • UHA is secondary insurance carrier?*
    • Tip: Submit your claim with primary insurance carrier’s EOB (Explanation of Benefits)/RA (Remittance Advice).

*You may also apply this information for previously denied claims resubmitted for reimbursement reconsideration

Tip #3: How to Complete the CMS-1500 Claim Form

Box 21 – DIAGNOSIS OR NATURE OF ILLNESS OR INJURY – ICD INDICATOR
Use the ICD-9 or ICD-10 code for each current diagnosis applicable to that visit. Do not put any description for each diagnosis code. The new form requires that codes be entered in the correct order following the alphabetical reference numbers (A-L) codes are entered left to right (alphabetical order), 4 codes per row, and up to 3 rows. NOTE: This is different from the old CMS form where only up to 4 codes can be entered and according to the numerical order.

UHA recommends that the diagnosis reference numbers (A-L) be used in COLUMN 24E to correspond with the services.

“ICD IND” Use this space to indicate if the diagnosis codes being used are ICD-9 or ICD-10 codes. An indicator of “9” would represent ICD-9 codes and a “0” indicator would represent ICD-10. This is a required field.

Please contact Customer Services if you require assistance.​

Addressing Returned / Denied Claims

Tip #1: Common Reasons for Claim Denials

Here are three common reasons a claim may be denied and some helpful tips to get your claims paid without delay:

  1. Denial Reason: “Duplicate claim”:
    • Check other claims to see if the service was paid on another claim;
    • If the service in question was not paid on another claim:
  2. Denial Reason: “Exceeded timely filing”:
  3. Denial Reason: “No Prior Authorization on file”:

Tip #2: Timely Filing Waivers

Acceptable reasons for timely filing waivers:

  • Claim submission within 12 months from date of service
  • Claim submission within 12 months from date of denial
  • Claim submission within 12 months from newborn enrollment
  • Claim submission within 12 months from primary carrier’s payments
  • Claim submission within 12 months of third party liability payer exhaust denial (must provide dated denial)

If none of the above reasons apply, a Claim Filing Waiver Form may be submitted with one of the following documents that support attempts of earlier claims submissions:

  • Copy of the electronic claim denial/rejection notification
  • Dated correspondence from UHA with claim information detailing why claim was rejected
  • Dated confirmation of claim receipt

When requesting a waiver, please use the Timely Claim Filing Waiver Form.

If you have any questions regarding timely filing, please contact Customer Services at (808) 532-4000, extension 351, from Oahu or (800) 458-4600, extension 351, from the neighbor islands.

Tip #3: Resubmissions, Corrections, and Reconsiderations

  1. What should you do if you are asked to resubmit a claim with notes?
    • Submit a paper claim with medical notes attached and write “Resubmission” at the top right hand corner.
  2. What should you do if there is a denial on your claim that you disagree with?
    • Complete and submit a “Claim Reconsideration Request” form along with your medical notes.
    • Do not submit a claim with the “Claim Reconsideration Request” form to avoid a duplicate claim denial.
  3. What should you do if you would like to make a correction on a previously submitted claim?
    • Submit a paper claim and write the words “Corrected Claim” at the top right hand corner.
    • Please ensure that the corrected claim matches your original claim with the exception of the area(s) that is being corrected.See example below:

Original Claim


Corrected Claim

(Line 1: CPT changed to 99213 / Lines 2 & 3 identical to original claim)

Express Scripts: Pharmacy Benefits Manager (PBM)

What is UHA's Pharmacy Benefits Management Company?

UHA switched over to Express Scripts as of June 1, 2016 in response to customer feedback and our desire to rein in the skyrocketing costs of prescription drugs. In order for UHA to care for the  needs of our members, we have to align ourselves with partners who will be able to help us curb costs. Because of its size and position in the industry, Express Scripts offers more competitive pricing and service for our members.

What is Care Continuum?

Some medications, such as injectables, infusions, and some specialty drugs are part of a member’s medical benefit rather than the pharmacy benefit. Express Scripts not only manages our pharmacy benefits for our members (PBM), but through their company Care Continuum, they can also manage medications under the member’s medical benefits (MBM). There is a MBM v. PBM Drug Lookup tool available here.

Express Scripts: Claims

Where can pharmacists call for claims processing questions?

Pharmacists can call the Pharmacy Help desk at (800) 922-1557 to assist with claims processing for medications managed under the member’s pharmacy benefit (PBM) at any time of the day or night.

For help with claims processed according to the member’s medical benefit (MBM), pharmacists can call UHA Customer Services, Monday – Friday, 8am to 4pm Hawaii Standard Time, at (808) 532-4000, Toll free: (800) 458-4600.

Express Scripts: Formulary

What drugs are excluded?

Please see the list of excluded medications and their alternatives: Express Scripts.

Express Scripts: Prior Authorizations

My patient just changed plans to UHA. How will I know if my patient’s prescription medications require a prior authorization, if they are non-covered, or if they are non-preferred under their drug coverage?

 We recommend that you visit uhahealth.com/express-scripts to see if there will be changes to the coverage of your patient’s medications:

  • Which medications are included in our Formulary and which medications will require PA, step therapy, or have a quantity limit
  • Which medications will not be covered

How do I enter PA requests for my patient's medications?

For fastest service visit Express Scripts’ provider portal at express-path.com.

  • This one-stop site will allow you to submit PA requests for medications managed under the member’s pharmacy benefit (PBM) and those managed under the medical benefit (MBM). In most cases you will be able to receive a real-time response. You can also set up email notifications which will send updates either on a daily basis, or if you prefer, only when a decision has been made.
  • PA requests for medications that are managed under the member’s pharmacy benefit may also be submitted via covermymeds.
  • Physicians may also call in PA requests for medications managed under the member’s pharmacy benefit (PBM) at any time of the day or night. And in most cases, you will get a real-time response.
    • PBM Phone: (800) 753-2851
    • PBM Fax: (877) 251-5896
  • For PA requests for medications managed under the member’s medical benefit, call Care Continuum, the plan’s Medical Benefit Manager (MBM), Monday – Friday, 8am to 10pm Eastern Standard Time.  Messages received after business hours will be returned the next business day.
    • MBM Phone: (866) 877-7042 (Press Option #1 for PA questions)
    • MBM Fax: (866) 877-7179

How can pharmacists check on PA status for patients prior to administering or dispensing?

Pharmacists may call the MBM or PBM phone number to obtain status on PA’s or check with the provider’s office who submitted the PA. The Pharmacy can register at ExpressPAth also and submit PA. They can receive email notifications of status on a daily basis, or just when the decision has been made. Once ESI approves a PA, they will fax a notification to both the prescribing physician and the pharmacy listed on the PA.

  • PBM Phone: (800) 753–2851
  • MBM Phone: (866) 877-7042

How do I know which medications are managed under the member's medical benefit (MBM) and which are under the pharmacy benefit (PBM)?

Many injectable, infusion and specialty medications are managed under the member’s MBM rather than the PBM. Submitting PA requests via ExpressPAth eliminates the need to differentiate between the two. PA requests for drugs managed as a medical benefit or as a pharmacy benefit may both be submitted on the same user friendly website express-path.com.

If you choose a different submission method, you can find out which medications are managed by the member’s medical benefit (MBM), and which are managed by the member’s pharmacy benefit (PBM) by using the MBM v. PBM Drug Lookup tool available on the Drug Search for Providers tab of the Find Care Providers & Drugs page.

What are UHA’s utilization management requirements?

These clinical programs protect your patient’s health and save them money: step therapy (ST), drug quantity management (QL) and prior authorization (PA):

Step Therapy

  • Step therapy is a program for patients who take prescription medicine regularly to treat a long-term condition, such as arthritis, asthma or high blood pressure. It lets patients get the treatment they need affordably. It helps the plan sponsor maintain prescription-drug coverage for everyone the plan covers. In step therapy, medicines are grouped in categories based on treatment and cost.
  • First-line medicines are the first step. First-line medicines are generic and lower-cost brand-name medicines approved by the U.S. Food & Drug Administration (FDA). They are proven to be safe, effective and affordable. Step therapy suggests that patients should try these medicines first because in most cases they provide the same health benefit as more expensive drugs, but at a lower cost.
  • Second-line drugs are the second and third steps. Second-line drugs typically are brand-name drugs. They are best suited for the few patients who don’t respond to first-line medicines. Second-line drugs are the most expensive options.
  • Members who are currently taking a second line drug will not be asked to switch to a first line drug. They will be grandfathered indefinitely.
  • If you prescribe a new medication for a patient with a step therapy requirement, they will be asked to try a first-line medication before a second-line medication.

Drug Quantity Management

  • The drug quantity management program makes sure that patients are getting the right amount of medication and that is prescribed in the least wasteful way. For example, you instruct your patient to take two 20mg pills each morning. If that medication was also available in 40mg pills, we would reach out to you about prescribing one 40mg pill a day instead of two 20mg pills. In addition, if you wrote the original prescription for 30 pills (a 15-day supply), the new prescription for 30 pills would last a full month — and the patient would have just one copayment, not two.
  • This program also makes sure that the prescription doesn’t exceed the amount of medication that the plan covers. If the prescription is for too large a quantity, the pharmacist can fill the prescription for the amount that the plan covers or contact you to discuss other options, such as increasing to a higher strength or getting a prior authorization for the quantity originally prescribed.

Prior Authorization

  • When a prescription requires prior authorization, you can submit a PA request to Express Scripts or prescribe a different medication that is covered by the plan.

How do I register for the ExpressPAth portal?

Registration is quick and easy! Visit provider.express-path.com.

You can register with only 6 simple steps and log in right away to begin submitting PA’s online. A tutorial can be found here.

As a provider who submits prior authorizations, is there training information available for my staff to learn how to submit PAs?

Please see the ExpressPAth Portal User Guide for step by step illustrations.

Where are the PA forms for medications?

With electronic prior authorization, spend more time with patients and less time faxing. Visit express-path.com to submit PA requests any time day or night and in most cases receive a response right away.

How do I request an expedited review?

Using the online PA portal, ExpressPAth, or submitting your PA via phone, is the fastest way to receive a response. In most cases you will receive a real-time answer, and if approved, the patient will be able to pick up their medications right away.

Express Scripts: Appeals

What if I want to appeal a decision made by Express Scripts?

If you disagree with a decision reviewed under the member’s pharmacy benefit (PBM), you may contact UHA’s Health Care Service Department Monday-Friday from 8am to 4pm HST to request a peer-to-peer conversation within 30 days of the denial. We will arrange a time for you to speak with our Medical Director or Chief Medical Officer to discuss reconsideration. If you would like to submit a formal, written appeal to UHA, please follow our appeals process described here.

If you disagree with a decision made by CareContinuum (MBM), please contact them at (866) 877-7042, Monday-Friday: 8am-10pm EST. With CareContinuum you will be able to request a peer to peer or submit a formal written appeal.

Express Scripts: Contact Information

Do I have to call Express Scripts, or can I call UHA's customer service line?

Express Scripts can answer your questions quickly and accurately around the clock for questions about drugs managed under the member’s pharmacy benefit (PBM). For medications managed under the member’s medical benefit (MBM), any calls received outside of business hours will be returned the next business day.

UHA’s phone lines are also available from 8am to 4pm, Monday through Friday, except for major holidays. A representative can be reached at: 808-532-4000 (or 800-458-4600 from the neighbor islands) at the following extensions:

  • Customer Services: ext. 297 
  • Health Care Services: ext. 300 
  • Employer Services: ext. 299
  • Premium Billing: ext. 353

Express Scripts Contact Information

PBM:

  • Member Customer Service: Specific number for member inquiries; listed on the back of the member ID cards.
    Phone: (855) 891-7978
    Available 24/7
  • Prior Authorizations: Contact for physicians to call or fax in PHARMACY prior authorizations.
    Phone: (800) 753 – 2851
    Fax: (877) 251-5896
    Available 24/7
  • Pharmacy Help Desk: For pharmacy use only to assist with getting a claim to adjudicate or understanding a reject message.
    Phone: (800) 922-1557
    Available 24/7
  • TDD: Member Customer Service number for hearing impaired members.
    Phone: (800) 759-1089
    Available 24/7

MBM:

  • Prior Authorizations: Contact for physicians to call or fax in MEDICAL drug prior authorizations.
    Phone: (866) 877-7042
    Fax: (866) 877-7179
    Mon – Fri 8AM – 10PM (EST), 2AM – 4PM (HST)

The forms and documents on this page require the free Adobe Acrobat Reader. Please download Adobe Reader.

COVID-19 Vaccine

Q1. When can my family and I receive our COVID-19 vaccines?

As of May 12th, 2021, all Hawaii residents age 12 and older are eligible for COVID-19 vaccinations. If you are under 18 years old, you will need parental/guardian consent and you may be limited to a certain type of vaccine that you are authorized to take. Please refer to the Hawaii Department of Health COVID-19 vaccine page for updates.

HDOH Phase 2 announcement

Source: hawaiicovid19.com/vaccine

For the most detailed and up-to-date information, please see hawaiicovid19.com.

Q2. How will my family and I get the vaccine?

Please refer to the HDOH COVID-19 vaccine registration page for links to help you find a location you can take your vaccination and how to register. You can also search for available appointments by vaccine type here.

Q3. Someone I know is a kupuna who qualifies for the COVID-19 vaccine but is uncomfortable with the online registration system. How else can they make an appointment?

 The HDOH has a new service for kupuna that simplifies the COVID-19 vaccination registration process. View the Department of Health news release here.

  • Seniors or family caregivers can call 2-1-1 to reach Aloha United Way’s team of trained specialists. This service is available seven days a week for those age 65 and older. Call 2-1-1 for personalized assistance in navigating the registration process and securing appointments. The team can also help eligible individuals arrange for transportation to a vaccination provider.
  • Aloha United Way’s 2-1-1 team is responsible for the initial intake process. Information is then securely electronically transferred to the St. Francis Healthcare System call center team. St. Francis will follow up with kupuna who have called AUW’s 2-1-1 within 24 to 48 hours.

Q4. Could my employer require me to take the vaccine?

For more information, please see your human resources manager or other company executive.

Q5. Could my children’s school require them to take the vaccine?

Schools are likely to have their own policies, so please contact your children’s principal. We also encourage you to talk to your children’s pediatrician, who will provide guidance knowing their health and medical history.

Q6. Are there side effects from the vaccine?

For information on potential side effects, please see cdc.gov. We also highly encourage you to talk to your primary care physician, who knows your health and medical history.

Q7. Will there be a co-pay?

No. There is no co-pay to receive the COVID-19 vaccine, even from an out-of-network provider. As with the flu shot, this critical vaccine will be provided at $0 co-pay.

Q8. I had COVID-19 and recovered, so should I take the vaccine when it’s made available to me?

We highly encourage you to talk to your primary care physician, who knows your health and medical history.

Q9. I have concerns about the safety of the COVID-19 vaccine. How can I know that it is safe?

The FDA has approved the COVID-19 vaccines. For more information, please see cdc.gov. We also highly encourage you to talk to your primary care physician, who knows your health and medical history.

Q10. Where can I learn more about COVID-19 and vaccine developments?

For the most comprehensive and up-to-date information, please see the Centers for Disease Control (CDC) and Prevention at cdc.gov.

Q11. Where can I learn more about Hawaii’s vaccination plans?

Please see the HDOH at hawaiicovid19.com/vaccine.

An executive summary of the State of Hawai‘i’s draft COVID-19 vaccination plan is available here or view the full draft plan here.

COVID-19 Testing: Stay up to date with the latest CDC guidelines

Q1. What if I have been in close contact with a COVID-19 infected person?

If you have been in close contact with someone with suspected or confirmed COVID-19, whether you are fully vaccinated or not, you should first be evaluated by your healthcare provider and be tested for COVID-19 if indicated to do so.

Q2. Will UHA cover COVID-19 testing if I currently show no COVID-19 symptoms (am asymptomatic)?

UHA will cover COVID-19 diagnostic testing when the test is, at the time of service, in accordance with updated CDC guidelines. Coverage is subject to change contingent upon evolving CDC guidelines. UHA will not cover non-diagnostic testing.

Q3. Under what circumstances should I obtain a COVID-19 test?

The CDC recommends the following individuals should obtain COVID-19 diagnostic testing:

  1. People who have symptoms of COVID-19 who are fully vaccinated with the COVID-19 vaccine should first be evaluated by their healthcare provider and be tested for COVID-19 if indicated to do so.
  2. People without symptoms of COVID-19 who are not fully vaccinated with the COVID-19 vaccine: 
    • who have been in close contact with someone with suspected or confirmed COVID-19, should first be evaluated by their healthcare provider and be tested for COVID-19 if indicated to do so.
    • who have taken part in activities that put them at higher risk for COVID-19, such as travel, attending large social or mass gatherings, or being in crowded indoor settings.
    • who have been asked or referred to get tested by their school, workplace, healthcare provider, state, tribal, local, or territorial health department.

Please review the remaining questions and answers as to whether UHA will provide coverage for a COVID-19 test in specific situations.

Q4. Does UHA cover employer requested or required COVID-19 “screening?”

No. A screening test for COVID-19 is not covered by your UHA plan. A “screening test” for COVID-19 is a test administered to someone with no symptoms. The HDOH and CDC do not currently recommend testing for people who do not have symptoms.

Q5. How do I get COVID-19 testing?

Start with a call to your doctor. If you’re sick and experiencing flu-like symptoms, such as cough or difficulty breathing, and think you have been exposed to COVID-19, call your doctor (primary care physician / PCP) for medical advice. If you’re able, monitor and report your temperature. Your doctor will determine whether you should be tested and can best instruct you on next best steps, including the most appropriate care location to visit and testing protocols.

Q6. Is COVID-19 testing covered by UHA?

Yes, UHA covers 100% for appropriate, medically necessary testing for COVID-19. The guidelines for testing are provided by the CDC and HDOH. Current CDC guidelines can be found here.

Q7. Does UHA cover COVID-19 antibody testing now that it’s available?

UHA covers antibody tests (serology) when medically necessary and only if one of these CDC guideline criteria are met under the guidance of a provider:

  1. You have been ill for 9 to 14 days and CDC guidelines call for an antibody (blood) test plus the standard COVID-19 (nose swab) test for a more conclusive diagnosis.
  2. Your child has complications that his or her physician determines is related to COVID-19, such as an inflammatory syndrome in children (e.g., as Kawasaki disease or an illness similar to toxic shock).

The test is not currently designed to test individuals wanting to know if they have been previously infected with COVID-19.

Furthermore, the American Medical Association has taken a position on not using serology testing for the sole determination of immunity to COVID-19 secondary to testing limitations along with potential false positive and/or negative results. Read their guidance here.

Therefore, UHA will not pay for antibody tests if the test is solely to show immunity to COVID- 19.

Q8. Does UHA cover COVID-19 testing for travel purposes?

No. UHA does not cover COVID-19 testing for travel purposes.

Q9. When does UHA cover at-home COVID-19 tests?

COVID-19 tests intended for at-home testing are covered when the test is ordered by an attending health care provider who has determined that the test is medically appropriate for the individual based on current accepted standards of medical practice and the test otherwise meets federal statutory criteria. The guidelines for testing are provided by the CDC and HDOH. Current CDC guidelines can be found here.

Q10. Will UHA reimburse me for the cost of an at-home COVID-19 test?

Assuming your purchase of the COVID-19 at-home test meets the criteria described above in Q9, UHA will cover 100%. Contact Customer Services for assistance with filing your claim. For additional details on UHA’s claims process click here.

COVID-19 Coverage: General Questions

Q1. Does my coverage include telehealth (phone or video) visits with my physician?

UHA covers telehealth visits with participating providers at 100%.* We encourage you to seek care from your primary care physician first. Your own doctor will know your medical history and needs best. If your physician is not a participating provider, UHA may cover some costs but you will be responsible for any additional charges that exceed UHA’s standard rates.

Visit our Telehealth page to learn more.

*Telehealth covered at 100% of eligible charges with no copay or deductibles when rendered by a participating provider in UHA’s network. This level of coverage is valid only for the duration of the federal COVID-19 state of emergency. The conditions for the coverage of telehealth copays can be found in UHA’s current Telehealth Services payment policy. Or call UHA to find out more.

Q2. How else can I get virtual care during this time?

UHA members will have expanded access to UHA’s team of RN Care Specialists and clinical team to answer questions about accessing medical care, medications or how to care for yourself at home. Call (808) 532-4006, or toll free at 1-(800) 458-4600, ext. 300, Monday through Friday from 8 a.m. to 4 p.m.

UHA covers telehealth visits with participating providers at 100%.* We encourage you to seek care from your primary care physician first. Your own doctor will know your medical history and needs best. If you don’t have a primary care physician, you may access virtual care from the resources below. Standard benefits apply when members have a telehealth visit with a non-participating provider.**

*Telehealth covered at 100% of eligible charges with no copay or deductibles when rendered by a participating provider in UHA’s network. This level of coverage is valid only for the duration of the federal COVID-19 state of emergency. The conditions for the coverage of telehealth copays can be found in UHA’s current Telehealth Services payment policy. Or call UHA to find out more.

**Unless the non-participating provider telehealth service is related to a COVID-19 diagnosis.

Virtual Care Resources

The Queen’s Health Systems COVID-19 Hotline
If you are experiencing symptoms you believe may be linked to COVID-19, talk to a Registered Nurse and get your questions answered.
Hours: 24/7
COVID-19 Infoline: 808-691-2619
(Dial 1 first if calling from a neighbor island.)
Website: www.queens.org/covid19/what-queens-is-doing

Hawai’i Pacific Health

Hawai’i Pacific Health COVID-19 Virtual Clinic for Video and Phone Visits
The Virtual Clinic’s purpose is to address patients with signs and symptoms of COVID-19 who are well enough to be evaluated without coming to the office and others who have concerns about COVID-19 exposure.

Patients should reach out to their own primary care physician (PCP) for treatment and guidance before contacting the Virtual Clinic. Patients without a PCP are encouraged to contact the Virtual Clinic directly.
Hours: 8AM – 8PM
Phone: 808-462-5430 (press option 2)
Website: https://www.hawaiipacifichealth.org/hph-covid-19-updates/covid-19-testing

MyChart
Connect with your PCP for non-COVID related health issues via MyChart. You can message your doctor or send an electronic visit request.

First Vitals
For mild to moderate symptoms of COVID-19, telehealth consults can help reduce the novel coronavirus from spreading from person to person and is a more efficient way to receive initial care. Book a 15-minute video consult with a medical professional at: http://www.covidhawaii.com.

Q3. What do I do if I develop flu-like symptoms, but don’t have a personal physician/PCP?

For those experiencing flu-like symptoms without shortness of breath and no history of serious medical problems that could compromise your health, going to an urgent care facility is appropriate. Please call the urgent care facility in advance to get any pre-arrival instructions that will help prevent spreading of your illness to others.

However, go immediately to the emergency room if you have any of the following: a rapid pulse, a temperature of over 103 degrees lasting for several days or shortness of breath.

Q4. What is the coverage for the diagnosis of COVID-19?

Effective March 1, 2020 and until the federal COVID-19 state of emergency ends, coinsurance requirements are waived for these services when related to a COVID-19 diagnosis. This includes:

  • Doctor’s office visits 
  • Urgent care facilities 
  • Emergency room 
  • Telehealth visits* 
  • Virtual check-in
  • E-visits

*Telehealth covered at 100% of eligible charges with no copay or deductibles when rendered by a participating provider in UHA’s network. This level of coverage is valid only for the duration of the federal COVID-19 state of emergency. The conditions for the coverage of telehealth copays can be found in UHA’s current Telehealth Services payment policy. Or call UHA to find out more.

Q5. If I get COVID-19 and need hospitalization, is that covered?

Yes. All copay, coinsurance, or deductible coinsurance requirements are waived and UHA will provide 100% of the eligible charge for medically necessary hospitalization with a UHA participating facility and their UHA participating providers related to a COVID-19 diagnosis. At this time, the waiver applies to all admissions with a date of service from April 1, 2020. This is a temporarily enhanced coverage of benefits which is subject to change. Coverage was extended as of January 1, 2021.

For help finding a participating provider in UHA’s network, visit the UHA Care Provider Search tool.

Q6. Am I able to get an extended supply of my medication(s)?

UHA encourages our members to limit any necessary trips to the pharmacy by utilizing their 90-day mail-order benefit or the extended fill available though most UHA-participating retail pharmacies within the Express Scripts network. Learn more here.

You can sign up for mail order delivery to your home for free. Just visit Express-Scripts.com to sign up. Once you are enrolled, they will even contact your physician when your prescription runs out.

Q7. What are UHA and Express Scripts® doing to address potential drug shortages related to the current COVID-19 outbreak?

UHA’s Pharmacy Benefits Manager, Express Scripts, is closely monitoring the global manufacturing environment. At this time, they don’t see any disruptions to the supply chain that will affect their ability to fill prescriptions for UHA members, now and in the near future. Given the fluid nature of the COVID-19 outbreak, Express Scripts will continue to monitor the situation and work with their suppliers as needed. UHA will continue to work with Express Scripts to address issues and service our members.

Q8. How is UHA ensuring the health of its own employees?

To ensure that we can be here for you, we’ve been actively working with UHA’s own associates to safeguard their health. To the extent possible, our associates have begun telecommuting and practicing several other social distancing measures so we can continue to serve our members, employers and providers.

Q9. Where can I get general information about coronavirus and COVID-19?

We recommend the following government web sites for general information about coronavirus during this time:
https://www.cdc.gov
https://health.hawaii.gov/docd/advisories/novel-coronavirus-2019/

Q10. I think there may be an error on my claim. What can I do?

The process for COVID-19 related claims is new to everyone, it’s possible there may be mistakes made. Rest assured, we will work quickly to resolve any issues. We appreciate your patience as we work through this.

If you have any questions or need assistance, please contact Customer Services.

Customer Services
Phone: (808) 532-4000
Toll free: (800) 458-4600

Q11. I have been let go or have had my hours reduced by my employer. What are my options for health insurance?

UHA is committed to your health. This pandemic has led to a multitude of changes for Hawaii’s workforce. For those who have been let go by their employers or have had their hours reduced, we have resources to help you stay informed and navigate your options.

Individual Plan Transition Resources

  • To check if you’re eligible for Medicaid and to learn more about how you can apply, visit medquest.hawaii.gov for more information.
  • For other individual health plan options and possible subsidies to help receive coverage, visit the Federal Marketplace at healthcare.gov.

If after reviewing these online resources, you find that you need further assistance, contact Customer Services to speak to a representative.

Customer Services
(808) 532-4000
1 (800) 458-4600 (toll free)
Leave us a message

COVID-19 Additional Resources for Members

Q1. What mental health resources are available if I've experienced mental or emotional hardship during the pandemic?

The HDOH developed a new program, Kū Makani—The Hawai‘i Resiliency Project, offering dedicated crisis counseling to callers facing emotional fallout related to the COVID-19 pandemic.

  • Kū Makani has an array of services to help residents experiencing anxiety, depression, panic or just feeling overwhelmed by the challenges of the pandemic.
  • This is a FREE service.
  • To reach a trained Kū Makani counselor, call the Hawai’i CARES
    • hotline: Oahu – (808) 832-3100
    • Neighbor Islands: Maui, Kauai, and Hawaii – 1 (800) 753-6879 Kū Makani crisis counseling hours:
      • 4:00 p.m. – 9:00 p.m. Monday-Friday
      • 9:00a.m. –9:00 p.m. Saturday and Sunday
  • Visit the Kū Makani website and social media for detail about the program, services, upcoming events, and island- specific resources: kumakani.org
  • For non-pandemic counseling and services, including crisis support, mental health resources and substance use treatment services, you may always call the Hawai‘i CARES hotline 24/7 at 1 (800) 753-6879 or text “ALOHA” to 741741.

COVID 19: Telehealth Policy/Guidelines

Q1. What are the guidelines/criteria for Telehealth Services?

For full details, please see our Telehealth Services payment policy.

Telehealth services are covered (subject to Limitations and Administrative Guidelines) when all criteria are met as stated in our policy. The policy will cover criteria such as, but not limited to:

  • Methods of how the service is delivered (video/audio, telephone calls, platform, etc.)
  • Geographic restrictions on a patient’s or health care provider’s location

For assistance with questions regarding our policy, please email or call Customer Services at:

Customer Services
Phone: (808) 532-4000
Toll free: (800) 458-4600
Email: Customer Services Contact Form

Q2. What are the guidelines/criteria for Telehealth Services for Behavioral Health?

The services we cover for behavioral health are listed in our medical payment policy. As long as the criteria/guidelines for telehealth services are met, we will cover those specific behavioral health services.

Q3. Are we allowed to use mobile apps such as FaceTime, Skype, or Zoom for telehealth?

Yes, as long as all telehealth criteria are met.

The Health and Human Services Office for Civil Rights (OCR) will exercise its enforcement discretion and will not pursue otherwise applicable penalties for breaches that result from the good faith provision of telehealth services during the federal COVID-19 state of emergency. Visit the telehealth criteria for more information.

COVID 19: Telehealth Payment, Coverage, Reimbursement, Coding

Q1. What code(s) is UHA using for a specific service?

A detailed list of accepted codes and the description of services for each are available in our Telehealth Services policy. If you do not see a service or code listed in our policy, please contact Customer Services to verify if coverage is available.

Customer Services
Phone: (808) 532-4000
Toll free: (800) 458-4600
Email: Customer Services Contact Form

Q2. Is reimbursement the same for Telehealth Services as it is for in-office services?

Reimbursement is defined in your contract terms. If you have any questions regarding reimbursement, please email Contracting Services.

Q3. How do we bill for Telehealth Services?

Please continue to submit your claims to UHA. We would prefer electronic billing. If you wish to sign up to submit your claims electronically please visit our page on Provider Claims Submission. If you are interested in receiving payments from UHA electronically, please sign up for EFT payments by following these instructions: logging into your Online Provider Services account, navigating to the “Forms” tab, and completing the Authorization for EFT Request Form and sending it to our Contracting Services department.

Q4. I think there may be an error on my claim. What can I do?

The process for COVID-19 related claims is new to everyone, it’s possible there may be mistakes made. Rest assured, we will work quickly to resolve any issues. We appreciate your patience as we work through this.

If you have any questions or need assistance, please contact Customer Services.

Customer Services
Phone: (808) 532-4000
Toll free: (800) 458-4600
Email: Customer Services Contact Form

COVID-19 Testing and Diagnosis FAQs

Q1. What codes are being used by UHA for COVID-19 diagnosis or treatment?

Claims submitted with the following ICD-10 diagnosis codes defined by the Center for Disease Control (CDC) will be identified as the diagnosis or treatment of COVID-19.

Claims without the CDC identified COVID-19 related diagnosis codes will be processed to include co-pays, coinsurance and deductibles defined in the member’s plan medical benefits guide. We appreciate you working with us to ensure those individuals and families affected by COVID-19 are not negatively financially impacted.

  • U07.1: Confirmed diagnosis (see CDC Coding Guidelines for all scenarios)
  • Z03.818: Encounter for observation for suspected exposure to other biological agents ruled out.
  • Z20.828: Contact with and (suspected) exposure to other viral communicable diseases.
  • Z11.59: Encounter for screening for other viral diseases

Reference: CDC Coding Guidelines

Q2. How can I find out if my healthcare provider is a participating provider?

UHA will cover appropriate, medically necessary diagnostic testing for COVID-19, per Centers for Disease Control and Prevention (CDC) guidelines and Hawaii Department of Health’s (HDOH) mandated coverage. Current CDC guidelines can be found here.

Q3. What is UHA’s coverage for telehealth visits related to COVID-19 diagnosis?

Regardless of the primary purpose of the visit, 100% of eligible charges with no copay or deductibles will be covered on any telehealth service rendered with a participating provider in UHA’s network during the federal COVID-19 state of emergency.

All telehealth visits are covered at 100% of eligible charge when related to COVID-19 diagnosis, effective 3/01/20. This includes visits to a doctor’s office, urgent care facilities, emergency room, telehealth visits, virtual check-in, and e-visits. This means that UHA members diagnosed with COVID-19 will have all associated copayments, coinsurance, and deductibles covered whether or not the services received are from a UHA participating or non-participating provider. However, standard benefits apply when members have a telehealth visit with a non-participating provider.*

*Telehealth covered at 100% of eligible charges with no copay or deductibles when rendered by a participating provider in UHA’s network. Benefits valid only for the duration of the federal COVID-19 state of emergency. The conditions for the coverage of telehealth copays can be found in UHA’s current Telehealth Services Payment Policy. Or call UHA to find out more.

Q4. Does UHA cover COVID-19 antibody testing now that it's available?

UHA covers antibody tests (serology) when medically necessary and only if one of these CDC guideline criteria are met under the guidance of a provider:

  1. When an individual has been ill with COVID-19 symptoms for 9 to 14 days and a diagnosis must be established using the antibody test in addition to recommended direct detection methods such as the standard COVID-19 nose swab polymerase chain reaction (PCR) tests.
  2. In evaluating a child with complications that may be related to COVID-19, such as an inflammatory syndrome in children (such as Kawasaki disease or an illness similar to toxic shock).

The test is not currently designed to test individuals wanting to know if they have been previously infected with COVID-19.

Furthermore, the American Medical Association has taken a position on not using serology testing for the sole determination of immunity to COVID-19 secondary to testing limitations along with potential false positive and/or negative results. Read their guidance here.

Therefore, UHA will not pay for antibody tests if the test is solely to show immunity to COVID-19.

COVID-19 serology (IgG or IgM) testing (commonly known as “antibody testing”) is a covered benefit only when the test meets the definition of “medical necessity.” While we completely support clinical advancements that improve diagnosis, treatment, and prevention of COVID-19, serologic testing is complicated. The antibody testing is not currently recognized by the CDC as a valid diagnostic test for COVID- 19 or a reliable test to demonstrate immunity, and serology testing is not known to be effective in improving health outcomes.

Accordingly, UHA does not endorse and will not cover tests without FDA standing and insists that the ordering provider be qualified to interpret the results in the context of the clinical situation and the public health milieu.

This is a rapidly changing situation that we will continue to monitor using the latest guidance from the CDC and DOH to determine which tests are medically necessary. As guidelines and recommendations evolve, we’ll continue to re-evaluate our policies.

COVID-19 Vaccine For Employers

Q1. When can my employees receive their COVID-19 vaccines?

Priority for vaccines has been determined by the Centers for Disease Control and Prevention and the Hawaii State Department of Health (HDOH). View the Executive Summary of the Vaccination Plan here.

Recommendations from the Hawaii COVID‐19 Vaccine Allocation and Prioritization Working Group in conjunction with HDOH subject matter experts were used to identify the population groups below. Strong consideration was given to CDC Guidance and adherence to ACIP recommendations (See Figure ES‐6: Vaccine Prioritization Phases).

Source: Hawaii COVID-19 Executive Summary of the Vaccination Plan

For the most detailed and up-to-date information, please see hawaiicovid19.com.

Q2. How can my employees get the vaccine?

Those who meet the criteria for each phase will be able to get the vaccine through any approved COVID-19 vaccine provider, as supplies allow.

Q3. I have an employee who is a kupuna and qualifies for the COVID-19 vaccine but they are uncomfortable with the online registration system. How else can they make an appointment?

The HDOH has a new service for kupuna that simplifies the COVID-19 vaccination registration process. View the HDOH news release here.

  • Seniors or family caregivers can call 2-1-1 to reach Aloha United Way’s team of trained specialists. This service is available seven days a week for those age 65 and older. Call 2-1-1 for personalized assistance in navigating the registration process and securing appointments. The team can also help eligible individuals arrange for transportation to a vaccination provider.
  • Aloha United Way’s 2-1-1 team is responsible for the initial intake process. Information is then securely electronically transferred to the St. Francis Healthcare System call center team. St. Francis will follow up with kupuna who have called AUW’s 2-1-1 within 24 to 48 hours.

Q4. May I require my employees to take the vaccine?

For more information, please contact your own legal counsel.

Q5. Will there be a co-pay?

No. There is no co-pay to receive the COVID-19 vaccine, even from an out-of-network provider. As with the flu shot, this critical vaccine will be provided at $0 co-pay.

Q6. Could UHA set-up COVID-19 vaccine clinics at my organization like is often done with flu shots?

As of this time, we do not anticipate setting up vaccine clinics in our members’ place of business because of a number of unprecedented challenges, including requirements for storage and temperature monitoring equipment, as well as other issues.

Q7. I have concerns about the safety of the COVID-19 vaccine. How can I know that it is safe?

The FDA has approved the COVID-19 vaccines. For more information, please see cdc.gov.

Q8. Where can I learn more about COVID-19 and vaccine developments?

For the most comprehensive and up-to-date information, please see the Centers for Disease Control and Prevention at cdc.gov.

Q9. Where can I learn more about Hawaii’s vaccination plans?

Please see the HDOH at hawaiicovid19.com/vaccine.

An executive summary of the State of Hawai‘i’s draft COVID-19 vaccination plan is available here or view the full draft plan here.

COVID-19 Testing: Stay up to date with the latest CDC guidelines

Q1. What if my employees have been in close contact with a COVID-19 infected co-worker?

If your employee has been in close contact with someone with suspected or confirmed COVID-19, whether they are fully vaccinated or not, they should first be evaluated by their healthcare provider and be tested for COVID-19 if indicated to do so.

Q2. Does UHA cover COVID-19 testing of those who are asymptomatic?

UHA will cover COVID-19 diagnostic testing when the test is, at the time of service, in accordance with updated CDC guidelines. Coverage is subject to change contingent upon evolving CDC guidelines.  UHA will not cover non-diagnostic testing.

Q3. Under what circumstances should my employees obtain a COVID-19 test?

The CDC recommends the following individuals should obtain COVID-19 diagnostic testing:

  1. People who have symptoms of COVID-19 who are fully vaccinated with the COVID-19 vaccine should first be evaluated by their healthcare provider and be tested for COVID-19 if indicated to do so.
  2. People without symptoms of COVID-19 who are not fully vaccinated with the COVID-19 vaccine:
    • who have been in close contact with someone with suspected or confirmed COVID-19, should first be evaluated by their healthcare provider and be tested for COVID-19 if indicated to do so.
    • who have taken part in activities that put them at higher risk for COVID-19, such as travel, attending large social or mass gatherings, or being in crowded indoor settings.
    • who have been asked or referred to get tested by their school, workplace, healthcare provider, state, tribal, local, or territorial health department.

Please review the remaining questions and answers as to whether UHA will provide coverage for a COVID-19 test in specific situations.

Q4. Does UHA cover employer requested COVID-19 testing or testing for employment purposes?

No. Testing requested by employers or testing to screen for general workplace health and safety (such as an employee “return to work” program),or testing for employment purposes are not covered by UHA plans. This aligns with UHA’s Medical Benefits Guide (MBG) and the guidance recently issued by the federal tri- agencies (U.S. departments of: Labor, Health and Human Services, and Treasury).

Eligibility and Premiums

What is ARPA?

The American Rescue Plan Act of 2021 (ARPA) was signed by President Biden in March 2021. It includes a number of provisions designed to assist workers impacted by the COVID-19 pandemic.

How does ARPA affect COBRA or impact my company?

Among the provisions of this new law is a COBRA premium subsidy that pays for 100% of the applicable COBRA premium for eligible individuals for coverage periods beginning April 1, 2021 and ending September 30, 2021.

If your group health plan is subject to COBRA, there are new COBRA notice requirements for employers and additional COBRA election opportunities for assistance-eligible individuals starting April 1, 2021.

How can I find out more about ARPA’s COBRA subsidy and this new law?

Every employer’s situation is unique, so you must consult with your business and/or legal counsel for specific advice for your company. Please note that when contacted by any members who will be impacted by this new law, we are directing them back to their former employers. Please contact your former employer.

We also suggest that employers check the U.S. Department of Labor website regularly for updates should they become available.

I may need to furlough my employees or reduce their work hours. Can I continue to provide health coverage to my employees if they fall below the minimum required hours for eligibility?

Yes, UHA will allow for continuation of coverage due to the COVID-19 pandemic. Please contact your Client Services Liaison or Coordinator at (808) 532-4000, ext. 358 or toll free 1-(800) 458-4600, ext. 358 or email [email protected].

Can the 4-week waiting period be waived for employees who re-enroll at the end of a furlough or if they are rehired?

Yes, UHA will waive waiting-period requirements for members who were furloughed or displaced due to the COVID-19 pandemic, but then later return to work. Please contact your Client Services Liaison or Coordinator for details: (808) 532-4000, ext. 358 or toll free 1-(800) 458-4600, ext. 358 or email [email protected].

Can I change my medical plan to reduce costs?

Depending on your regulatory plan status, you can change medical plans during the COVID-19 pandemic. Please keep in mind that the change may increase out-of-pocket expenses for your employees. Also, please note this is a process that does take some time; UHA must approve the change in plans and be given time to make the change. We recommend at least 60 days to properly execute the change and for you to properly notify your employees.

Can I make temporary changes to my drug, vision and dental riders to reduce costs?

Please contact your Client Services Liaison or Coordinator to determine if your plan status will allow for these changes. Depending on your regulatory plan status, you may be able to make changes to your drug, vision and dental riders. We are here to guide you as current regulations may not permit the exclusion of certain riders. Call us at (808) 532-4000, ext. 358 or toll free 1-(800) 458-4600, ext. 356 or email [email protected].

What if I cannot pay my premiums by the first of the month?

Because health plan coverage begins on the 1st of the month, Hawaii law requires premium payments to be made by that date to avoid a lapse in coverage.

If you anticipate a delay in making a premium payment, please contact one of our Billing Representatives immediately to discuss your alternatives.

UHA is required to give companies 10-day advance notice that a lapse in coverage will occur if payment is not received within the notice period. Again, if you do anticipate a delay in payment or receive a notice of impending termination of your coverage, please call us immediately to discuss payment options. We recognize that the current COVID-19 situation calls for difficult decisions; we want to work with you as every organization is facing different circumstances.

Call us at (808) 532-4000, ext. 353 or toll free 1-(800) 458-4600, ext. 353 or email billing@uhahealth.com.

Where can I find information on federal and state relief funds for small businesses?

The CARES Act was signed into federal law on March 27, 2020, to provide billions of dollars in relief for American workers and small businesses. It was designed to offer multiple funding options for those seeking relief.

This act established new temporary programs to address the COVID-19 outbreak and provide several Coronavirus relief options:

  1. Paycheck Protection Program – An SBA loan that helps businesses keep their workforce employed during the Coronavirus (COVID-19) crisis.
  2. EIDL (Economic Injury Disaster Loan) Emergency Advance – This loan advance will provide up to $10,000 of economic relief to businesses that are currently experiencing temporary difficulties.
  3. SBA Express Bridge Loan – Enables small businesses who currently have a business relationship with an SBA Express Lender to access up to $25,000 quickly.
  4. SBA Debt Relief – The SBA is providing a financial reprieve to small businesses during the COVID-19 pandemic.

For more information, please visit the U.S. Small Business Administration website.

Beginning May 18, 2020, the City and County of Honolulu launched a COVID-19 reimbursement program for small businesses called the Small Business Relief and Recovery Fund. Please click on the link for more details.

Local applications for CARES funding can be found at the following:

We recommend that you discuss these programs with your financial and/or tax professional to determine which programs might be the best option for you and your business.

Additional Resources

What mental health resources are available if I or my employees experienced mental or emotional hardship during the pandemic?

The HDOH developed a new program, Kū Makani—The Hawai‘i Resiliency Project, offering dedicated crisis counseling to callers facing emotional fallout related to the COVID-19 pandemic.

  • Kū Makani has an array of services to help residents experiencing anxiety, depression, panic or just feeling overwhelmed by the challenges of the pandemic.
  • This is a FREE service.
  • To reach a trained Kū Makani counselor, call the Hawai’I CARES
    • hotline: Oahu – (808) 832-3100
    • Neighbor Islands: Maui, Kauai, and Hawaii – 1 (800) 753-6879 Kū Makani crisis counseling hours:
      • 4:00 p.m. – 9:00 p.m. Monday-Friday
      • 9:00a.m. – 9:00 p.m. Saturday and Sunday
  • Visit the Kū Makani website and social media for detail about the program, services, upcoming events, and island-specific resources: kumakani.org
  • For non-pandemic counseling and services, including crisis support, mental health resources and substance use treatment services, you may always call the Hawai‘i CARES hotline 24/7 at 1 (800) 753- 6879 or text “ALOHA” to 741741.