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Hawaii



Medical Financial Assistance Program

Having trouble paying for your Kaiser Permanente medical and pharmacy expenses?

Kaiser Foundation Hospitals and Kaiser Foundation Health Plans, collectively referred to as Kaiser Permanente, are committed to providing programs that facilitate access to care for vulnerable populations. This commitment includes providing financial assistance to qualified low income, uninsured and underinsured patients when the ability to pay for services is a barrier to accessing emergency and medically necessary care. Patients must meet the eligibility requirements below to qualify.

Who is eligible for Financial Assistance and what are the requirements?

The Medical Financial Assistance (MFA) program helps low-income, uninsured, or underinsured patients who need help paying for all or part of their medical care received from Kaiser Permanente. Patients are eligible for financial assistance when their family income is at or below 400% of the Federal Poverty Guidelines (FPG). Patients should consult with a counselor to determine eligibility and for assistance applying. Patients who have experienced unusually high medical expenses may be eligible for the program, regardless of household income. Refer to the MFA Policy for a complete description of the program eligibility requirements.

What does the program cover?

The MFA program covers emergency and medically necessary health care services, pharmacy services and products, and medical supplies provided at Kaiser Permanente facilities (i.e. hospitals, medical centers, and medical office buildings), at Kaiser Permanente outpatient pharmacies, or by Kaiser Permanente providers. Services that are not considered emergent or medically necessary as determined by a Kaiser Permanente provider include, but are not limited to cosmetic surgery or services, infertility treatments, retail medical supplies, surrogacy services, and services related to third party liability, or workers’ compensation cases. Refer to the MFA Policy for a complete list of eligible and ineligible services.

Which Providers are and are not covered under the program?

The list of providers in Kaiser Foundation Hospitals that are and are not covered under the MFA policy can be found in our Kaiser Permanente Provider list of Hawaii.

How can I get program information?

Copies of the MFA policy, application forms, instructions, and plain language summaries (e.g., policy summaries or program brochures) are available to the general public, without charge, from Kaiser Permanente’s website, by email, in person, by telephone, or by U.S. postal mail.

Download program information: Electronic copies of program information are available:

Medical Financial Assistance Policy (English)
More languages coming soon

Chinese, Japanese, Korean, Laotian, Spanish, Tagalog, Vietnamese

Program Summary (English)
Click here for more languages

Chinese, Japanese, Korean, Laotian, Spanish, Tagalog, Vietnamese

Program Application (English)
Click here for more languages

Chinese, Japanese, Korean, Laotian, Spanish, Tagalog, Vietnamese

Request program information electronically: Electronic copies of program information are available by email upon request. Call 808-432-7940 to request electronic copies. Please be prepared to provide an email address that the information can be sent to when calling.

Obtain program information in person: Program information is available at Admitting and Emergency Room Departments in Kaiser Foundation Hospitals.  Counselors are also available at Kaiser Permanente medical centers and medical office buildings to provide program information and to quickly determine MFA eligibility.  Counselors are available Monday – Friday, 8:30 a.m. – 4:30 p.m. at the Business Services Office in each of the following Kaiser Permanente facilities:

Moanalua Medical Center / Mapunapuna Clinic
Honolulu Clinic, Windward Clinics, Hawaii Kai Clinic and Ala Moana Clinic
Leeward Clinics
Maui Clinics
Big Island Clinics

Request program information by telephone: Counselors are available by telephone to provide information, determine MFA eligibility, and assist a patient to apply for MFA. Counselors can be reached Monday – Friday, 8:30 a.m. – 4:30 p.m. at:

Moanalua Medical Center / Mapunapuna Clinic 808-432-7940
Honolulu Clinic, Windward Clinics, Hawaii Kai Clinic and Ala Moana Clinic 808-432-2020
Leeward Clinics 808-432-3297
Maui Clinics 808-243-6580
Big Island Clinics 800-598-5928 (toll free)

Request program information by mail: A patient can request program information by mail. Information requests can be mailed to:

Kaiser Permanente
Attention: Medical Financial Assistance Unit
Business Services Dept. / Financial Counselors
3288 Moanalua Road
Honolulu, HI 96819

How do I apply?

A patient can apply for the MFA program, during or following the care received from Kaiser Permanente, in several ways including in person with a counselor, or by submitting a complete paper application.

Apply in person: Counselors are available at Kaiser Permanente medical centers and medical office buildings to quickly determine MFA eligibility. Counselors are available at the Business Services Office in each of the following Kaiser Permanente facilities:

Moanalua Medical Center
Waipio Medical Office Building
Honolulu Medical Office Building
Wailuku Medical Office Building

Complete and submit a program application: Please mail completed applications or deliver it in person (including all required documentation and information specified in the application instructions) to:

Kaiser Permanente
Attention: Business Services Dept. / Financial Counselors
3288 Moanalua Road
Honolulu, Hawaii 96819

Kaiser Permanente will review submitted applications when they are complete and will determine whether you are eligible according to the Kaiser Permanente Medical Financial Assistance Policy. Incomplete applications may result in a delay in processing or denial of your MFA application, but Kaiser Permanente will notify applicants and provide an opportunity to send in the missing documentation or information, by the required deadline.

Amounts Generally Billed (AGB)

Amounts Generally Billed (AGB) is based on the lowest average of the amounts that were paid to a Kaiser facility by Medicare fee-for-service and Medicaid fee-for-service (and co-pays and deductibles) for emergency or medically necessary services, based on actual claim data from November 1, 2014 to October 31, 2015, which is consistent with the look-back method. Total expected payment from allowed claims was divided by total billed charges for such claims, and that number was subtracted from 1 to calculate the AGB percentage. The 2016 AGB reduction to gross charges is 63% for hospital charges and 65% for professional charges.

Is there language assistance?

Interpreters are available to you at no cost. The medical financial assistance application, policy, and the policy summary may be available in your language. For more information, call 1-808-432-5955.

Other beneficial programs and extra resources:

If you don’t have health care coverage and would like more information, visit healthcare.gov or call 1-800-318-2596.

This may be a hard time for you financially. If you need help paying for needs other than health care, there are community resources and programs that can help. For more information on programs that may save you money, visit myadvocatehelps.com. Examples include:

          • Food stamps through the Supplemental Nutrition Assistance Program (SNAP)
          • Local food pantries and community centers
          • Transportation assistance.

Need help?

For help or questions about the Medical Financial Assistance application process or other questions, please call 808-432-7940, or speak to a Financial Counselor within the Business Services Department at the Kaiser Permanente hospital.