RCUH Policies and Procedures
MEDICAL PLANS
(Includes: Drug, Vision, Chiropractic)
Coverage Tier
Employee (EE)
Employer (ER)
TOTAL (EE + ER)
HMSA Preferred Provider
(PPO)
Single Plan
$299.39
$449.09
$748.48
2-‐Party Plan
$598.77
$898.15
$1,496.92
3+ Family Plan
$1,047.98
$1,571.98
$2,619.96
HMSA Comprehensive Medical
(Comp)
Single Plan
$238.10
$357.14
$595.24
2-‐Party Plan
$476.16
$714.24
$1,190.40
3+ Family Plan
$833.39
$1,250.09
$2,083.48
HMSA Comprehensive Medical Basic (ACA Plan – Outside Hawaiʻi)
(Comp B)
Single Plan
$208.26
$312.40
$520.66
2-‐Party Plan
$416.51
$624.77
$1,041.28
3+ Family Plan
$729.02
$1,093.52
$1,822.54
HMSA Health Plan Hawaiʻi Plus
Hawaiʻi Residents Only
(HPH)
Single Plan
$274.70
$412.06
$686.76
2-‐Party Plan
$549.39
$824.09
$1,373.48
3+ Family Plan
$961.53
$1,442.29
$2,403.82
HMSA Health Plan Hawaiʻi Basic
Hawaiʻi Residents Only
(HNP)
Single Plan
$237.20
$355.80
$593.00
2-‐Party Plan
$474.39
$711.59
$1,185.98
3+ Family Plan
$830.28
$1,245.42
$2,075.70
Kaiser Plan A
(ACA Plan – Hawaiʻi Residents)
Hawaiʻi Residents Only
(PLANA)
Single Plan
$199.33
$299.00
$498.33
2-‐Party Plan
$398.67
$598.00
$996.67
3+ Family Plan
$697.67
$1,046.51
$1,744.18
Kaiser Plan B
Hawaiʻi Residents Only
(PLANB)
Single Plan
$231.16
$346.74
$577.90
2-‐Party Plan
$462.32
$693.47
$1,155.79
3+ Family Plan
$809.05
$1,213.59
$2,022.64
DENTAL PLAN
Coverage Tier
Employee (EE)
Employer (ER)
TOTAL (EE + ER)
Hawaii Dental Service (HDS) Plan
Single Plan
$14.12
$21.19
$35.31
2-‐Party Plan
$28.24
$42.36
$70.60
3+ Family Plan
$46.40
$69.61
$116.01
Monthly Premiums for medical and dental plans are collected the pay period prior to the coverage month. (For example, July premiums are collected during the June 16-30th pay period and reflected on the July 7th pay stub).
Updated 04/25/2022
RCUH MONTHLY PREMIUMS FOR JULY 1, 2021 – JUNE 30, 2022
MEDICAL PLANS
Coverage Tier
Employee (EE)
Employer (ER)
TOTAL (EE + ER)
HMSA Preferred Provider
(Includes: Drug, Vision, Chiropractic)
Single Plan
$258.44
$387.66
$646.10
2-‐Party Plan
$516.88
$775.32
$1,292.20
3+ Family Plan
$904.54
$1,356.82
$2,261.36
HMSA Comprehensive Medical
(Includes: Drug, Vision, Chiropractic)
Single Plan
$216.42
$324.64
$541.06
2-‐Party Plan
$432.84
$649.26
$1,082.10
3+ Family Plan
$757.47
$1,136.21
$1,893.68
HMSA Comprehensive Medical Basic (ACA Plan)
(Includes: Drug, Vision, Chiropractic)
Single Plan
$189.69
$284.53
$474.22
2-‐Party Plan
$379.38
$569.06
$948.44
3+ Family Plan
$663.91
$995.87
$1,659.78
HMSA Health Plan Hawaiʻi Plus
(Includes: Drug, Vision, Chiropractic)
Single Plan
$247.72
$371.58
$619.30
2-‐Party Plan
$495.43
$743.15
$1,238.58
3+ Family Plan
$867.00
$1,300.50
$2,167.50
HMSA Health Plan Hawaiʻi Basic
(Includes: Drug, Vision, Chiropractic)
Single Plan
$217.82
$326.74
$544.56
2-‐Party Plan
$435.65
$653.47
$1,089.12
3+ Family Plan
$762.38
$1,143.58
$1,905.96
Kaiser Plan A
(Includes: Drug, Vision, Chiropractic)
Single Plan
$199.33
$299.00
$498.33
2-‐Party Plan
$398.67
$598.00
$996.67
3+ Family Plan
$697.67
$1,046.51
$1,744.18
Kaiser Plan B
(Includes: Drug, Vision, Chiropractic)
Single Plan
$231.16
$346.74
$577.90
2-‐Party Plan
$462.32
$693.47
$1,155.79
3+ Family Plan
$809.05
$1,213.59
$2,022.64
DENTAL PLAN
Coverage Tier
Employee (EE)
Employer (ER)
TOTAL (EE + ER)
Hawaii Dental Service (HDS) Plan
Single Plan
$14.12
$21.19
$35.31
2-‐Party Plan
$28.24
$42.36
$70.60
3+ Family Plan
$46.40
$69.61
$116.01
Monthly Premiums for medical and dental plans are collected the pay period prior to the coverage month. (For example, July premiums are collected during the June 16-30th pay period and reflected on the July 7th pay stub).
Updated 05/03/2021