2019 HMSA Medicare Advantage Application Instructions

Thanks for choosing HMSA Medicare Advantage.

PPO plans (except Dual Care)

  • Complete
  • Complete Plus
  • Standard
  • Standard Plus

HMO plan

  • Essential Advantage

When to enroll

You can enroll in HMSA Akamai Advantage (PPO) or Essential Advantage (HMO) when you’re eligible for Medicare Part A and enrolled in Part B.

To use your plan benefits as soon as possible, we need 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, 2018, with a proposed start date of January 1, 2019. You may also qualify for a special election period.

What you’ll need

  • A copy of your Medicare card or letter from the Social Security Administration or the Railroad Retirement Board.*
  • Your HMSA subscriber ID number, if you have one.
  • Your primary care provider’s (PCP’s) name. If you don’t have a PCP, let us know and we can help you find one.
  • The date you’d like your health plan to start.
  • If you (the applicant) are unable to sign, your legal representative may sign for you. Your representative must fill in their name, mailing address, telephone number, and their relationship to you (the applicant).

*Don’t mail your Original Medicare card with your application.

Before you send

Complete all sections of the form accurately and write legibly so we can process your application without any delays. Be sure to choose the correct form for the health plan you’re applying for. On Oahu, the PPO plans are Complete and Complete Plus. On Oahu, the HMO plan is Essential Advantage. On the Neighbor Islands, the PPO plans are Standard and Standard Plus. Call us for more information.

Please don’t send payment with your application.

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 the completed application to 808-948-6343.