Enrollment Application – Please confirm eligibility with your employer before enrolling yourself or a dependent in your HMAA health plan.
View our health plans and administrative procedures for more information. For further assistance, contact Enrollments.
Request to Enroll
Employers may use this form to submit Enrollment Applications and/or supporting documentation for Qualifying Events (e.g., birth or marriage certificate).
If you are not the authorized contact, please obtain authorization from him/her to submit this request.
For assistance, contact Enrollments.