Welcome Students

Enrollment E-Consent

Please read this information carefully and print a copy and/or retain this information electronically for future reference.

Recent legislation allows individuals and corporations to complete legal transactions online. By providing your consent to the Hawaii Medical Service Association in the manner set forth below, you will be able to complete your online enrollment with the Hawaii Medical Service Association. As a member who has provided consent for legal communication to take place electronically, you will also be able to update your personal information online and receive legal notification of changes to terms and conditions to your insurance plan as an electronic message.

With your consent, the Hawaii Medical Service Association will be better able to meet your needs as a member.

If you prefer not to enroll with the Hawaii Medical Service Association online, you may print the form, complete it, and mail it to HMSA, CCS/6, P.O. Box 860, Honolulu, HI 96808-0860.

Disclosures to You by HMSA and Your Consent to the Use of Electronic Records

Your consent is being sought by the Hawaii Medical Service Association, its subsidiaries and its and their agents and licensees (collectively "HMSA"). HMSA makes these disclosures to you, prior to asking you to consent to the use of an electronic record to provide or make available information to you (and/or your spouse, child or minor).

  1. Summary of Your Consent. After you have reviewed these disclosures, you will be asked to give your consent (your "Consent") to HMSA’s use of an electronic record in addition to records in paper format to provide or make available to you (and your spouse, child and/or minor) any legally required disclosures, notices and information related to your (and your spouse's, child's and/or minor's) online enrollment or membership in HMSA (your Membership"), sent to you (and your spouse, child and/or minor) by HMSA or its representatives during the course of your (and your spouse's, child's and/or minor's) relationship with HMSA via any HMSA web site or by e-mail (collectively "Electronic Record(s)"), addressed to the Internet email address you supply to HMSA, subject to the conditions and other requirements discussed below. If you are enrolling your spouse, child and/or minor with HMSA, your Consent will apply to your spouse, child and/or minor.
  2. Hardware and Software Requirements. As of the date you are reading this paragraph 2, you represent to HMSA that your hardware and software meet the following minimum requirements for access to and retention of the Electronic Records:
    1. Web site browser at least equivalent to Microsoft Internet Explorer 4.0 and above, Netscape Navigator 4.0 and above, AOL 4.0 and above, and equipped with SSL security of no less than 40 bits (128 bits recommended).
    2. Internet email software reasonably capable of sending and receiving Internet e-mail messages to and from HMSA, as demonstrated in the method required below as part of the Consent, together with authorized access to an e-mail account with reasonable inbox and outbox message storage, and the ability to access information in web site locations visibly referenced by a link in an email message.
    3. Computer or other hardware device (together with appropriate operating system and application software), that is capable of accessing the public Internet using a modem or other interfacing hardware that provides connectivity to an Internet Service Provider via ordinary telephone lines, cable television, DSL, T1, or any other communications medium, or using a direct networked connection; and is reasonably capable of (i) storing Electronic Records in electronic format and accessing such stored Electronic Record, or (ii) printing Electronic Records on paper or converting Electronic Records to another medium that provides reasonable retention and access.
  3. Change in Hardware and Software Requirements. After you have given your Consent, if HMSA changes the hardware or software requirements needed for you to access or retain Electronic Records, and this change creates a material risk that you will not be able to access or retain a subsequent Electronic Record, HMSA agrees to provide you with a revised statement of the hardware and software requirements for access to and retention of the Electronic Records. After again providing you with the opportunity to consent or confirm your consent electronically in a manner that reasonably demonstrates that you can access Information in the electronic form that will be used to provide the Information, you will have the option to withdraw your Consent in accordance with the procedure in paragraph 4.
  4. Withdrawal of Consent. After you have given your Consent, you may withdraw your Consent to HMSA’s use of Electronic Records provided or made available to you after the date your withdrawal of consent is effective (the "Withdrawal Effective Date"). The Withdrawal Effective Date shall be the last day of the calendar month that is at least thirty (30) days after HMSA has received a written letter (authenticated by including your subscriber number) mailed to Hawaii Medical Service Association, ATTN: Privacy Office Student Plan, P.O. Box 860, Honolulu, HI 96808, (i) requesting such withdrawal, and (ii) providing a mailing address to which HMSA may send future paper documents in lieu of Electronic Records. HMSA agrees to acknowledge its receipt of your withdrawal by a letter mailed to the address specified in your withdrawal letter. There will be no fee charged by HMSA for your withdrawal of Consent. Any withdrawal of Consent shall have prospective effect only, and shall not affect the legal effectiveness, validity or enforceability of Electronic Records provided or made available to you prior to the Withdrawal Effective Date.
  5. Requesting a Paper Copy; Handling Fees. After you have given your Consent, if you desire any paper copies in addition to those you may choose to prepare yourself by downloading and printing out a copy of Electronic Records, you have the right or option to have provided or made available to you a paper copy of any Electronic Record relating to your Membership. You may exercise this right or option, by written letter (authenticated by including your subscriber number) specifically identifying the Electronic Record in question by date and subject matter, mailed via first class mail with sufficient postage to the Hawaii Medical Service Association, ATTN: Privacy Office Student Plan, P.O. Box 860, Honolulu, HI 96808, containing a self-addressed envelope stamped with first-class postage sufficient for the paper copies requested. HMSA reserves the right to charge a handling fee of $US 10.00 per request conditioned upon payment in advance by check or money order submitted by mail to HMSA, ATTN: Privacy Office Student Plan, P.O. Box 860, Honolulu, HI 96808.
  6. Supplying and Amending Your Email Address. After you have given your Consent to the use of Electronic Records, HMSA will provide you with Electronic Records constituting the HMSA Enrollment Instructions and the HMSA Student Plan Application. Your email address in the field next to the words "Preferred Email Address" on the Student Plan Application as submitted by you will initially become your email address that HMSA will use to contact you in the future for the purposes of sending you legal notices or otherwise, until you amend your E-Mail Address. You may amend your email Address or any other personal information by written letter to HMSA (authenticated by including your subscriber number) in the same manner as provided for withdrawal of Consent under paragraph 4. The effective date of the amendment shall be the last day of the calendar month at least 40 days following HMSA’s receipt of such amendment, with receipt evidenced in the same manner as withdrawal of Consent under paragraph 4.

Your Consent to the Use of Electronic Records and Demonstration of Your Ability to Access Information

BY CONSENTING TO THE USE OF ELECTRONIC RECORDS, YOU CERTIFY THAT YOU (AND YOUR SPOUSE) ARE OVER THE AGE OF 18 (OR A PARENT AND/OR GUARDIAN OF A MINOR UNDER THE AGE OF 18) AND THAT YOU CONSENT TO HAVING ALL DISCLOSURES PROVIDED OR MADE AVAILABLE TO YOU (AND YOUR SPOUSE, CHILD AND/OR MINOR) REGARDING YOUR (AND YOUR SPOUSE'S, CHILD'S AND/OR MINOR'S) HMSA MEMBERSHIP IN ELECTRONIC FORM AND TO DOING BUSINESS WITH HMSA ELECTRONICALLY.

IF YOU ARE UNDER THE AGE OF 18 AND/OR DO NOT AGREE TO HAVING ALL DISCLOSURES PROVIDED OR MADE AVAILABLE ONLINE, DO NOT CONSENT TO THE USE OF ELECTRONIC RECORDS.

CLICKING ON THE ELECTRONIC ENROLLMENT E-CONSENT BOX ON THE HOME PAGE CONSTITUTES YOUR SIGNATURE ON AN ELECTRONIC DOCUMENT FOR ALL PURPOSES AND SHALL HAVE THE SAME FORCE AND EFFECT AS IF YOU HAD AFFIXED YOUR SIGNATURE ON A PAPER COPY OF THE DOCUMENT.

The receipt of your Consent by HMSA will serve to demonstrate that you can access Information in electronic form provided or made available to you by the HMSA web site.