NEW KIAA Forms & Documents for Members

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Simplifying the Enrollment Process

In an effort to reduce time, paper work, and duplication, we are releasing an all-new, all-inclusive KIAA Health Plan Enrollment form.  This form is to be used for all Health Plan enrollments.  The subscriber would only need to fill out this form, instead of one form for each Health Plan (HMSA, Kaiser Permanente, and HDS).  There will be no need for a KIAA Change form when you submit the new KIAA Health Plan Enrollment Form, as your company authorization is part of the form. 

Download the new KIAA Health Plan Enrollment Form

Revised KIAA Change Form

Although you do need to submit a KIAA Change Form on all Enrollments, you still need to submit the KIAA Change Form for all other requests like:

  • Cancellations
  • Change of Name, Address, or Phone
  • Request new Membership Cards

Download the revised KIAA Change Form

New Summary of Benefits and Coverage (SBC)

As part of the Affordable Care Act (ACA), or better known as ObamaCare, Health plans are mandated to provide an easy-to-understand, summary of health benefits.  Each of the 13 different Health Plans offered by KIAA through HMSA and Kaiser Permanente have been uploaded to the secured Medical Member page on this website. 

Log-in to the secured member page to download the SBCs for the plans your company offers. 

Cory Aguiar

820 Piilani Street