Legal & Plan Documents – Hawaii
Summary of Benefits and Coverage
The health benefits available to you represent a significant component of your compensation package. They also provide important protection for you and your family in the case of illness or injury. The Summary of Benefits and Coverage (SBC) summarizes important benefit plan information in a standard format.
Description of Coverage
The Description of Coverage (DOC) contain important information about the HMAA plan’s coverage, limitations, and exclusions.
- 2023 HMAA Comprehensive Plus Medical Plan Summary
- 2024 HMAA Comprehensive Plus Medical Plan Summary
- 2023 HMAA Prescription Drug Summary
- 2024 HMAA Prescription Drug Summary
- 2023 HMAA Dental Summary
- 2024 HMAA Dental Summary
- 2023 HMAA Vision Summary
- 2024 HMAA Vision Summary
Enrollment Waiver Forms
Special Enrollment Rights Notice
This is an opportunity for certain individuals to enroll in a group health plan, regardless of the plan’s regular enrollment dates. These opportunities occur when you lose eligibility for other coverage or experience certain life events (marriage, birth, adoption, or placement for adoption).
Women’s Health and Cancer Rights Act of 1998
If you are enrolled in a medical plan, certain benefits are available for breast reconstruction in connection with a mastectomy.
Newborns’ and Mothers’ Health Protection Notice
If you are enrolled in medical coverage, this notice contains important information about hospital coverage following newborn delivery.
Medicare Part D Prescription Drug Notice
If you are eligible for or covered by Medicare, this notice contains important information about prescription coverage under the OSI Restaurant Partners, LLC Health Plan and your options under Medicare’s prescription drug coverage.
Marketplace Coverage Options Notice
To assist you as you evaluate options for you and your family, this notice provides some basic information about the Marketplace (HealthCare.gov).