QUEST Details and QUEST State Offices
What are the Hawaii QUEST eligibility requirements?
Requirements to be eligible for Hawaii QUEST include:
- be a Hawaii resident;
- meet citizenship status requirements;
- have a Social Security number;
- not be certified as blind or disabled
- not be age 65 or over:
- not be living in a public institution;
- have income not more than 100% of the current FPL except for pregnant women and children up to age 6, who may have income up to the amounts listed above;
- not be eligible for health insurance from your employer (except for AFDC and GA recipients).
- have assets not exceeding the Hawaii QUEST asset limits.
What are the Hawaii QUEST asset limits?
- $2,000 for a household of one;
- $3,000 for a household of two;
- $250 for each additional person.
- Asset limits do not apply to children under age 19 born after September 30, 1983 or to pregnant women for the duration of the pregnancy
How does Hawaii QUEST work?
If you are eligible for Hawaii QUEST, you will choose one medical plan to serve you and any family members who are in the program with you. All family members must enroll in the same medical plan.
If you do not make a choice, you will be assigned to a medical plan.
Do I get to choose my own doctor?
Yes. After you are enrolled in a plan, you will choose a Primary Care Provider (PCP) who will provide most of your care. When you have a medical problem, make an appointment with your PCP If you need to see a specialist, your PCP will refer you to one who is participating with your plan.
If you do not choose your family’s doctor(s), your plans will assign you providers. If the doctor you want is already full, you will have to choose another.
Your medical plan will send you a membership card and handbook. They will tell you how to get the care you need. Each plan has member services representatives to help you, plus toll-free telephone numbers for Neighbor Islands.
Does Hawaii QUEST cover medical and bills I already have?
If you utilized medical services occurring a maximum of 5 calendar days before the date we receive your application, those services will be covered if a medical provider provided the medical service.
Are Hawaii QUEST’s benefits the same for everyone in the program?
The basic medical benefits are the same for everyone, but individuals under age 21 receive some extra services, such as vaccinations and certain types of tests.
After I choose my medical plan, will I have to stay in that plan forever?
No. You may change your medical plan once a year during the “Annual Plan Change Period,” with changes effective January 1. Except during this annual plan change period and some exceptions, you must stay in your medical plan once you have chosen them.
How do I know when to contact the State and when to contact my plan? You should contact the State if:
- you have a question about eligibility:
- you get a job or change jobs;
- your income, assets or address change;
- you have a change in your family, such as a birth, a death, a divorce, a marriage or someone moves into or out of your home.
You should contact your plan if:
- you have questions about how to get the care you need;
- you lose or misplace your medical card;
- you need special assistance.
Coverage for Medically Necessary Services
Note: these services have no cost-sharing.
|Room and board for semi-private room Medical and surgical||No charge|
Intensive care and cardiac units
Operating room and specialized treatment rooms
Rehabilitative services and physical therapy
|Surgical and anesthetic supplies, drugs and medicines||No charge|
Organ and tissue transplant services, cornea, kidney and allogenic bone marrow
|Physician’s and surgeon’s visits||No charge|
|Laboratory, pathology, and radiology||No charge|
|Physician office visits||No charge|
Diagnostic x-ray examinations, laboratory, tests, radiation therapy and chemotherapy
|Drugs and chemicals for chemotherapy||No charge|
|Allergy testing and treatment (compounds/serum)||No charge|
|No chargeNo charge|
|Routine physical examinations||No charge|
|Breast/pelvic examinations and pap smear||No charge|
|Routine immunizations||No charge|
|Mass and new immunizations||No charge|
|Well baby care||No charge|
|Voluntary family planning including sterilizations||No charge|
|Pregnancy and Maternity Care|
|Prenatal care||No charge|
|X-ray and laboratory tests||No charge|
|Treatment of missed, threatened and elective abortions||No charge|
|Delivery of infant||No charge|
|Post-partum care||No charge|
|Emergency Room services||No charge|
|Emergent Condition||No charge|
|Urgent care||No charge|
|Ambulance Services Ground and air ambulance||No charge|
|Other Facility Services|
|Skilled nursing facility (for 60 days)||No charge|
|Outpatient or ambulatory surgery||No charge|
|Rehabilitation facility||No charge|
|Air transportation to or from a provider in the service area||No charge|
|Home health services|
|Other practitioner services (e.g., Nurse Midwife, etc.)||No charge|
|Prescribed medication including over-counter prescribed drugs, supplies||No charge|
|Eye examinations (refractions)||No charge|
|Eyeglasses (every 24 months)||No charge|
|Behavioral Health Services|
|Inpatient care (psychiatric and detoxification)|
|Ambulatory and crisis services||No charge|
|Day treatment and hospitalization||No charge|
|Methadone treatment services||No charge|
|Diagnostic and laboratory services||No charge|
|Physician services||No charge|
|Therapeutic services||No charge|
STATE QUEST OFFICES
|East Hawaii (Hilo)||808-933-0339||808-933-0344|
|West Hawaii (Kona)||808-327-4970||808-327-4975|
|‘Ohana Health Plan||1-888-846-4262|
|United HealthCare Community Plan||1-877-512-9357|