Frequently Asked Questions
Here is a List of Frequently Asked Questions About 'Ohana Health Plan.
If you have any other questions, please call Customer Service at 1-888-846-4262 (TTY 711). You can also submit your questions online.
Q: What is 'Ohana?
A: 'Ohana is a health plan offered by WellCare Health Insurance. The company provides Medicaid and Medicare health and prescription drug plans. WellCare serves millions of members.
Q: What is a Managed Care Health Plan?
A: Many people now get their health care benefits through managed care health plans. In a managed care health plan, members get most or all of their Medicaid services from one organization under contract with the state. 'Ohana managed care health plans are contracted by the Hawai‛i Department of Human Services.
'Ohana's plans work with:
- Doctors
- Specialists
- Hospitals
- Labs
- Home and community-based providers
- Other health care facilities
These providers make up the plan's provider network. They provide the benefits offered by Medicaid.
Q: What is QUEST Integration?
A: The new QUEST Integration program is a melding of several programs, including QUEST and QExA, into one statewide program providing managed care services to all of Hawaii's Medicaid members. Members include low-income individuals, families, children, and people who are aged, blind and/or disabled.
Q: How can I find out if I am eligible?
A: QUEST Integration serves Medicaid members of Hawai'i who meet certain low income and other requirements. Eligibility for the program is determined by Med-QUEST.
Q: Can I select a new PCP, or change my PCP, online?
A: Yes. Use our Find a Provider tool to look for a new PCP. To change your PCP online, you will have to register for our secure portal. It's fast and easy.
Q: How do I get paid back for a medicine covered under 'Ohana's Preferred Drug List (PDL)?
A: You can make a Direct Member Reimbursement (DMR) request.
Please include in each request:
- A completed, signed DMR form
- A detailed prescription receipt (no handwritten receipts) or a pharmacy printout that shows:
- Member name
- Pharmacy name
- Doctor name
- Drug name
- Drug strength
- Number dispensed
- A day's supply
- Amount you paid
- A cash register receipt that shows the date the drug was paid for and the amount that was paid
Q: Who can members call for more information?
A: Members can call 'Ohana Customer Service if they have problems with:
- A service provider
- Accessing health care
- Services received
Customer Service can be reached Monday–Friday at 1-888-846-4262 (TTY 711) 7:45 a.m. to 4:30 p.m. HST.
We can get interpreters for all languages. We have materials available in Ilocano, Vietnamese, Chinese (Traditional), Korean, large print, audio tapes and Braille. Sign language services are also available for hearing-impaired members. All of these services are available at no cost.
Q: What is the QUEST Integration Ombudsman Program?
A: The Hawai'i Department of Human Services (DHS) oversees the Medicaid Ombudsman Program. This program allows Hilopa'a, an independent reviewer, to look into concerns and complaints against Medicaid health plans. Their findings can help plans reach these goals:
- Making sure you have access to care
- Promoting quality of your care
- Making sure members like you are satisfied with QUEST Integration services
The Ombudsman program is available to all members. You can learn more by contacting the Hilopa'a Family to Family Health Information Center. You can visit their website at www.hilopaa.org. You can also call, Email or fax them using the contact information below:
O'ahu: 1-808-791-3467
Hawai'i: 1-808-333-3053
Maui and Lana'i: 1-808-270-1536
Moloka'i: 1-808-660-0063
Kaua'i: 1-808-240-0485
e-mail: ombudsman@hilopaa.org
Fax: 1-808-531-3595