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• Vendor Resources

  If you’re an HMSA vendor, you need to know HMSA’s standards of business conduct and how to identify and report Medicare fraud, waste, and abuse.

• Workers’ Compensation Questionnaire Form

  Learn how to fill out the Workers' Compensation Questionnaire form.

• HMSA’s Third-Party Liability Injury/Illness Report Form

  We want to know when you've been hurt in an accident that was caused by someone else. This form lets us know what happened and who's covering your care.

• Acknowledgement of Group Life and AD&D Coverage under Student Plan 19

  This form will help you appoint a beneficiary in the event of your accidental death or dismemberment.

• Request to Restrict Member Information Form

  You can request that we restrict the use or disclosure of information about you that we have.

• Request to Amend Member Information Form

  If something about your personal information has changed, use this form to get us up to speed.

• Request for Identity Password Form

  This form is used to ask that HMSA include a password when verifying your identity.

• Request Copies of Member Records

  You can use this form to ask us copies of your records with HMSA.

• Request for Confidential Communications

  This form is used to tell HMSA to send communications to you at a different address or by other means.

• Request an Accounting of Disclosures Form

  Fill out and submit this form to find out who we've shared your personal health information with.

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