Search

Search

Edit tags: forms

Results

• 2026 HMSA Individual Plan Application Instructions

  Get the application for 2026 HMSA Individual Plan Application here.

• Organization Determination (Request for Prior Authorization)

  Some services and medical care require a coverage decision by HMSA before they can be covered.

• HMSA Medicare Advantage Member Appeals

  You can ask us to recheck a decision about your health plan or prescription drug coverage for services or benefits you've received.

• 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 for External Review by an Independent Review Organization

  You can ask to have an independent review organization look over your appeal if you think we made a mistake.

• 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.

• Essential, Optimal, and Metallic Formulary Coverage Determination Request

  Need a prescription drug that’s not on your formulary? Get instructions on how to start the request process with your doctor.