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• Acknowledgement of Group Life and AD&D Coverage under Student Plan 19

  This form will help you appoint a beneficiary in the event of your accidental death or dismemberment.

• Request to Restrict Member Information Form

  You can request that we restrict the use or disclosure of information about you that we have.

• Request to Amend Member Information Form

  If something about your personal information has changed, use this form to get us up to speed.

• Coordination of Benefits Form

  If you have more than one health care insurer, HMSA will work with them to figure out what your benefits and payments for services are.

• How to Update Your Address with HMSA

  It's important to let us know when you change addresses to avoid any interruptions in your coverage. There are different steps depending on what plan you have.

• If You Have More than One Medical Plan

  If you have another health plan or insurance coverage similar to an HMSA plan, we'll coordinate benefits with your other coverage.

• How to Update Your Name with HMSA

  All name changes must be submitted to HMSA as a signed request in writing with by documentation of the new name, such as a marriage certificate.

• How Do I Change My Primary Care Provider?

  If you need to change your HMO primary care provider (PCP), call HMSA Customer Relations at 808-948-6372 on Oahu or 1-800-776-4672 toll-free.

• Calculating Your PPO Plan Coinsurance

  Learn how HMSA calculates your coinsurance for covered services with participating and nonparticipating providers.

• HMSA’s Care Access Assistance Program

  HMSA's Care Access Assistance Program makes it easier for HMSA members to see an HMSA participating specialist on another island.

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