- Member Enrollment Application – To enroll new eligible employees and their dependents.
- Group Information Change Form – To change group contact information or add or remove a Group Administrator.
- Business Application – For business name change or ownership change.
- Information Change Form – To update member information (e.g., address change, coverage termination, or employment status).
- Disabled Dependent Certification Form – To certify eligibility for disabled dependents aged 19 and older.
Forms and Information: Employers
Below is a list of printable forms and information for our Employers’ convenience.
Please confirm your plan coverage by referring to your HMAA group service agreement.
- Summary of Benefits and Coverage (SBC) – Summarizes information on certain health benefits and costs.
- Summary of Material Modifications – Summarizes important updates that have recently been made to your health plan.
- Precertification List – HMAA’s medical plans require precertification of certain services and procedures. This list specifies the services that require precertification and are subject to change at any time. Failure to obtain precertification may result in a reduction of benefits.
- Screening and Preventive Services – Lists the screening and preventive services with a grade of A or B from the U.S. Preventive Services Task Forms (USPSTF) that are covered under the Affordable Care Act (ACA). This list is updated annually.
- Prescription Plan Formulary – HMAA’s current drug formulary developed by our pharmacy benefit manager, Express Scripts. You may also search online for a particular drug by name.
As your health care partner, HMAA is here to help you navigate the changes brought by health care reform. Learn more about these changes and how the Affordable Care Act (ACA) may impact your business by using the resources below and viewing our Health Care Reform FAQs.
- Fact Sheets
- IRS Reporting for Employer Shared Responsibility – The ACA added sections 6055 and 6056 to the Internal Revenue Service (IRS) Code; requiring employers providing minimum essential coverage to report coverage offered by filing an information return with the IRS, and furnishing statements to the individual. This information will be used by the IRS to ensure compliance with the ACA Employer/Individual Shared Responsibility mandates. View the data points that we can provide to ALEs upon their request.
- ACA Employer Shared Responsibility – In accordance with the ACA, applicable large employers are required to offer minimum essential coverage to 70% (95% beginning in 2016 plan year and thereafter) of full-time employees and their eligible dependents in order to comply with the Employer Shared Responsibility Provision of the ACA.
We provide language translation services as an added communication support for assistance to our non-English speaking customers while on the phone or face-to-face with one of our employees or participating providers. Written translation services for a particular plan document are available upon request.Satisfaction Survey
Group Health Plan Administrator Satisfaction Survey – This survey is for our Group Health Plan Administrators to provide feedback to HMAA. The information collected from this survey will enable us to make improvements to our health plans and services, and will be kept strictly confidential.