2017 HMSA Akamai Advantage Dual Care Application Instructions


When to enroll

You can enroll in HMSA Akamai Advantage Dual Care 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 coverage to start.

Open Enrollment Dates

You can also apply during open enrollment, October 15 to December 7, 2016, with a proposed effective date of January 1, 2017 (subject to CMS approval). You may also qualify for a special election period.

What you’ll need

  • A copy of your Medicaid ID card or a copy of our Medicaid entitlement letter.
  • A copy of your Medicare card or Medicare entitlement letter from Social Security or the Railroad Retirement Board.
  • Your HMSA subscriber ID number, if you have one.
  • Your primary care physician’s name.
  • Know when you’d like your coverage 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).

Before you send

It’s important that the forms submitted are complete and accurate to avoid delays in starting your coverage.

Please do not send payment with your application.

Where to send

Once filled out, please mail the form to this address:

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

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