2019 HMSA Akamai Advantage Dual Care (PPO SNP) Application Instructions


When to enroll

If you are eligible to enroll in HMSA Akamai Advantage Dual Care, you can enroll at any time. Your plan will start the first day of the month following the month in which we receive your completed application and it is approved by CMS.

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 provider's (PCP's) name. If you don't have a PCP, let us know and we can help you find one.
  • 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

Complete all sections of the form accurately and write legibly so we can process your application without any delays.

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

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.