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• HMSA Medicare Advantage Plans Automatic Payments Form

  Have your HMSA Medicare Advantage premiums paid automatically each month when you fill out and submit this form. Most local banks, savings and loans, and credit unions participate.

• HMSA Individual Plan Automatic Payments Form

  You can avoid the stress of mailing your premiums to HMSA by signing up for automatic payment.

• Appointment of Medicare Representative

  As a Medicare beneficiary, you can appoint a representative to act on your behalf when requesting appeals or prescription drug coverage.

• 2026 HMSA Akamai Advantage Dual Care (PPO D-SNP) Application Instructions

  Fill out this form if you've just become eligible for HMSA Akamai Advantage Dual Care or are enrolling during the open enrollment period.

• 2026 HMSA Medicare Advantage Application Instructions

  Fill out this form if you've just become eligible for HMSA Medicare Advantage or are enrolling during the open enrollment period.

• 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.

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