Need to travel to another island for medical treatment? HMSA may be able to provide travel assistance to help you get the care you need. HMSA’s Care Access Assistance Program (CAAP) makes it easier for HMSA members to see an HMSA participating specialist on another island in the state for treatment of a particular medical condition.
HMSA members may be eligible for CAAP if:
- Specialty care from a participating provider isn’t available on your home island.
- Specialty care is available on your home island, but you can’t get an appointment soon enough.
Ask your physician or health care provider about HMSA’s Care Access Assistance Program or call HMSA at 1-800-776-4672 toll-free.
To request travel assistance, please print and fill out this form. Fax it to HMSA at the number below.
To avoid delays, please make sure your request is complete.
Please check the following boxes as appropriate: “HSTA,” “Care Access Assistance Program,” “Parent/Guardian for a Minor,” “Member to Book Flight,” and “HMSA to Book Flight.”
Contact Information: Fill in the contact person’s name, telephone number, and fax number.
Section A: Member Information
- Fill in the member’s HMSA subscriber number (from their HMSA card), full name, and birth date.
- Fill in the companion’s name for patients 17 years old or younger and indicate their relationship to the patient.
- Fill in the daytime phone number and name of a contact person.
Take the form to the referring provider’s office and have them fill out the rest of the information:
- Section B – ICD-9-CM/ICD-10-CM diagnosis code.
- Section C – Procedure/Service/Treatment information.
- Section D – Provider information.
- Section E – Reason for referral to specialist provider.
Fax the completed form to HMSA’s Medical Management department at 808-944-5600 on Oahu.
Once the form is submitted, you’ll be notified whether or not your request meets program guidelines.