HMSA’s University of Hawaii/Chaminade University Student Plan Enrollment

All enrollment and renewal applications must be completed online. In order to apply online you must have a permanent Hawai’i address in which you will be able to receive your semester bill and HMSA ID card. If one is not available, please wait till you secure a local address before applying online. For more information, please visit the following link:

If the statements below include a document link, you must open, read and close the document first before clicking on the checkbox to indicate your consent or acknowledgement.

I have read the Electronic Enrollment E-Consent and consent to doing business with HMSA
electronically.
I have read and accept the terms of the Notice of Privacy Practices.
I have read and accept the terms and conditions of enrollment for the UH/Chaminade Student Plan.
I acknowledge that the repatriation with Life/AD&D benefit is optional for a
Non-International Student new Enrollment and that there is an additional cost for the benefit.
(NOTE: All J-1 visa holders are required by Federal Law to have repatriation coverage.
For UH, all international students are required by University policy to have repatriation
coverage.) I have read and agree to the billing instructions.
I do not have Medicare parts A or B or SSDI.
(Note: In accordance with section 1882(d) of the Social Security Act, the University of
Hawaii/Chaminade Student plan is not available for individuals with Medicare coverage
(Part A or B or SSDI). Please contact HMSA at 808-948-6140 / toll-free 1-800-782-4672, if
further assistance is needed.)

Application Type

New enrollment.

Please be aware that your eligibility for the Student Plan is monitored throughout the semester(s).
Periodically HMSA and UH/Chaminade perform a recertification of eligibility which may occur
after the semester is already in progress. If UH/Chaminade is not able to confirm your eligibility,
HMSA will contact you to request a copy of your class schedule with credit hours.
If you are unable to furnish or do not have the appropriate number of credit hours
your coverage will be terminated retroactive back to the effective date of the semester.
All claims paid on your behalf will be deducted from your refund.