Med-QUEST

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.

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Hawaii QUEST
Coverage for Medically Necessary Services

Note: these services have no cost-sharing.

 

Inpatient Care
Room and board for semi-private room Medical and surgical	No charge
Intensive care and cardiac units	No charge
Operating room and specialized treatment rooms	No charge
Rehabilitative services and physical therapy	No charge
Surgical and anesthetic supplies, drugs and medicines	No charge
Organ and tissue transplant services, cornea, kidney and allogenic bone marrow	No charge
Physician’s and surgeon’s visits	No charge
Laboratory, pathology, and radiology	No charge
Outpatient Care
Physician office visits	No charge
Diagnostic x-ray examinations, laboratory, tests, radiation therapy and chemotherapy	No charge
Drugs and chemicals for chemotherapy	No charge
Allergy testing and treatment (compounds/serum)	No charge
Therapeutic service Physical therapy	No chargeNo charge
Speech and occupational therapy	No charge
Audiology	No charge
Preventive Services
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 Services
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
Hospice	No charge
Outpatient or ambulatory surgery	No charge
Rehabilitation facility	No charge
Other Services
Air transportation to or from a provider in the service area	No charge
Home health services
Skilled nursing and home health aides	No charge
Medical supplies and equipment	No charge
Other medically necessary home health services	No charge
Other practitioner services (e.g., Nurse Midwife, etc.)	No charge
Prescription Drugs
Prescribed medication including over-counter prescribed drugs, supplies	No charge
Vision
Eye examinations (refractions)	No charge
Every 12 months for members under 21
Every 24 months for members 21 and older
Eyeglasses (every 24 months)	No charge
Lost, broken or significantly damaged eyeglasses may be replaced if the loss, breakage or damage was beyond member’s control
Behavioral Health Services
Inpatient care (psychiatric and detoxification)
Room and board	No charge
Diagnostic services	No charge
Physician and other practitioner services	No charge
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

 

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STATE QUEST OFFICES

 

 

Offices	Phone	Fax
Oahu Applications Unit	808-587-3521	808-587-3543
Ongoing Unit	808-587-3540	808-587-3543
Kapolei Unit	808-692-7364	808-692-7379
Big Island
East Hawaii (Hilo)	808-933-0339	808-933-0344
West Hawaii (Kona)	808-327-4970	808-327-4975
Maui	808-243-5780	808-243-5788
Kauai	808-241-3575	808-241-3583
Molokai	808-553-1758	808-553-3833
Lanai	808-565-7102	808-565-6460
MEDICAL PLANS
AlohaCare
Oahu	1-808-973-1650
Neighbor Islands	1-800-434-1002
HMSA
Oahu	1-808-948-6486
Neighbor Islands	1-800-440-0640
Kaiser Permanente
Honolulu	1-808-432-5330
Neighbor Islands	1-800-651-2237
‘Ohana Health Plan	1-888-846-4262
United HealthCare Community Plan	1-877-512-9357