Forms and Information: Employers
Below is a list of forms and information for current and prospective Employer groups.
Business Enrollment – For Companies interested in enrolling with HMAA
Request a Quote
Member Enrollment & Personal Information
- Online Medical Quote - Request a preliminary quote electronically.
- Group Medical Quote - Request a preliminary quote via fax or mail.
Enrollment Application - To enroll new eligible employees and their dependents.
Information Change Form - To update Company or Member information (e.g., address change, coverage termination, or employment status).
COBRA Qualifying Event Form - For employees who are qualified for COBRA coverage. Note: COBRA coverage is available for employers with 20+ employees on more than 50% of its typical business days in the previous calendar year.
Disabled Dependent Certification Form - To certify eligibility for disabled dependents aged 19 and older.
Administrative Procedures – To assist you in coordinating your organization’s health benefits program with HMAA
Information Change Form - To update Company or Member information (e.g., address change, coverage termination, or employment status).
COBRA Qualifying Event Form - For employees who are qualified for COBRA coverage. Note: COBRA coverage is available for employers with 20+ employees on more than 50% of its typical business days in the previous calendar year.
Disabled Dependent Certification Form - To certify eligibility for disabled dependents aged 19 and older.
Plan Benefits and Information
Pre-Certification Program - HMAA’s health plans require pre-certification of various services and procedures. This list specifies the services that require pre-certification and is subject to change at any time. Failure to obtain pre-certification may result in a reduction of benefits.
Summary of Material Modifications - This document summarizes important updates that have recently been made to your health plan.
Summary of Material Modifications - This document summarizes important updates that have recently been made to your health plan.
Honolulu, HI 96813