2017 HMSA Akamai Advantage Application Instructions

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Thanks for choosing HMSA Akamai Advantage.

When to enroll

You can enroll in HMSA Akamai Advantage when you’re eligible for Medicare Part A and enrolled in Part B. To be able to use your plan benefits as soon as possible, we need to have your application by the last day of the month before the month you’d like your health plan to start.

Open Enrollment Dates

You can also apply during open enrollment, October 15 to December 7, 2016, with a proposed start date of January 1. Please note that CMS will need to first approve your application. You may also qualify for a special election period.


What you’ll need

  • A copy of your Medicare card or letter from Social Security or the Railroad Retirement Board.
  • Your HMSA subscriber ID number, if you have one.
  • Your primary care physician’s name.
  • The date you’d like your health plan to start.
  • If you (the applicant) are unable to sign, your legal representative may sign by filling in their name, mailing address, telephone number, and their relationship to you (the applicant).

*Do not mail in your Original Medicare Card with your application.


Before you send

Please make sure you accurately complete all sections of the form and write legibly so we can process your application for you without any delays.

Please don’t send payment with your application. We’ll send you a monthly bill once your application is approved. Please pay your monthly premiums before the due date. Your premiums can be withheld from your Social Security Administration check or Railroad Retirement Board check if you chose this option on your application. If we don’t receive your premiums on time and reasonable attempts have been made to collect them, we’ll have to end your HMSA Akamai Advantage membership.


Where to send

Please mail your completed form to:

HMSA Akamai Advantage Sales
P.O. Box 3500
Honolulu, HI 96811-9983

You can also fax us the completed application to 808-948-6343.