Below is a list of printable forms and information for our Employers’ convenience.
- Administrative Procedures for Health Plan Administrators – To assist in coordinating your organization’s health benefits program with HMAA.
- 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.
- Summary of Benefits and Coverage (SBC) – Summarizes information on certain health benefits and costs.
- 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.
- Preventive Services Covered Under ACA – Lists the screening and preventive services that are covered under the Affordable Care Act (ACA). This list is updated annually or as required.
- Prescription Plan Information – View details on copayments, the formulary drug list, home delivery services, and online prescription account management.
Employer’s Guide to Health Benefits Under COBRA – Information for employers about health benefits under COBRA.
- Health Insurance Marketplace Coverage Options – In accordance with the ACA, employers are required to notify their members of information regarding employment-based health coverage offered and the Marketplace to buy health insurance.
- Fact Sheets
- ACA Employer Shared Responsibility – In accordance with the ACA’s Employer Shared Responsibility Provision, Applicable Large Employers (ALEs) are required to offer minimum essential coverage to 95% of their full-time employees and their eligible dependents.
- IRS Reporting for Employer Shared Responsibility – Sections 6055 and 6056 to the Internal Revenue Service Code require certain employers to report coverage offered by filing an information return with the IRS, and to furnish statements to individuals. View the data points that we can provide to Applicable Large Employers (ALEs) upon request.
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. Please contact us for assistance.
Spanish (Español): Para obtener asistencia en Español, llame al 1-888-941-4622.
Tagalog (Tagalog): Kung kailangan ninyo ang tulong sa Tagalog tumawag sa 1-888-941-4622.
Chinese (中文): 如果需要中文的帮助，请拨打这个号码 1-888-941-4622.