All participating providers in Hawaii will file claims to HMSA for you. (To check if your provider participates with HMSA, click here.) So will some nonparticipating providers. If your nonparticipating provider in Hawaii or an out-of-state provider doesn’t file a claim for you, you can submit your reimbursement request to us by doing one of the following:

• Send HMSA a Medical Receipts Form (or International Claim Form for out-of-country providers) and the necessary documentation using My Account. This recommended option typically results in the quickest processing time.
• Complete the fillable pdf form [PDF] or International claim form [PDF] found online, print it, and mail the claim with the necessary documentation to HMSA at the appropriate address.
• If you’re unable to submit your request online or print the fillable form, we require detailed paperwork to review your request. Please send a request to the appropriate address, include all of the following information with the necessary documentation, and allow for additional processing time:
  • Provider’s full name, phone number, and address.
  • Patient’s name and birth date.
  • Date(s) of services.
  • Date(s) of the injury or start of illness.
  • The charge for each service. Cost for services that are listed in a foreign currency will be converted to U.S. currency at the exchange rate on the date of service.
  • Description of each service.
  • Diagnosis or type of illness or injury.
  • Where the service was received (for example, doctor’s office, outpatient clinic, emergency room, or hospital).
  • Information about other health plans you may have.
  • A cover letter, which must include:
    • The name, date of birth, address, and HMSA membership number of the person who received the service or supply.
    • A daytime phone number where you can be reached.
    • A brief description of the service and/or why the service was needed.
    • Your signature.

Copies of the information and any supporting documents you send to HMSA should be clear and legible, with your HMSA subscriber number written on each page. Please keep the originals for your records because documents you submit to HMSA won’t be returned to you. Any missing information could delay processing of your request.

Note: Reimbursement requests must be received within a year from the last day on which services were received. For HMSA’s Plan for Federal Employees, reimbursement requests will be accepted until Dec. 31 of the year after the year services were received. Refer to the Federal plan brochure for more information.

To check the status of your claim, use My Account on hmsa.com.