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• HMSA Medicare Advantage Plans Automatic Payments Form

  Have your HMSA Medicare Advantage premiums paid automatically each month when you fill out and submit this form. Most local banks, savings and loans, and credit unions participate.

• HMSA Individual Plan Automatic Payments Form

  You can avoid the stress of mailing your premiums to HMSA by signing up for automatic payment.

• Appointment of Medicare Representative

  As a Medicare beneficiary, you can appoint a representative to act on your behalf when requesting appeals or prescription drug coverage.

• 2026 HMSA Akamai Advantage Dual Care (PPO D-SNP) Application Instructions

  Fill out this form if you've just become eligible for HMSA Akamai Advantage Dual Care or are enrolling during the open enrollment period.

• 2026 HMSA Medicare Advantage Application Instructions

  Fill out this form if you've just become eligible for HMSA Medicare Advantage or are enrolling during the open enrollment period.

• Vendor Resources

  If you’re an HMSA vendor, you need to know HMSA’s standards of business conduct and how to identify and report Medicare fraud, waste, and abuse.

• 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.

• Request for Identity Password Form

  This form is used to ask that HMSA include a password when verifying your identity.

• Request Copies of Member Records

  You can use this form to ask us copies of your records with HMSA.

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