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studentenrollment.hmsa.com Open in urlscan Pro
208.74.196.87  Public Scan

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Submitted URL: http://studentenrollment.hmsa.com/
Effective URL: https://studentenrollment.hmsa.com/
Submission: On January 04 via manual from US — Scanned from DE

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        <h1>HMSA’s University of Hawaii/Chaminade University Student Plan Enrollment</h1>
      </div>
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      <script type="text/javascript" src="resources/scripts/disclaimers.js"></script> <span id="container_ctl00_cphBody_cBody_cvAllChecks" class="error_msg" style="color:Red;display:none;">You must read and agree to, by checking, all of the notices
        listed below.</span>
      <div class="instruction">
        <h2 style="color:Red">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: </h2>
        <p> <a class="lbl_inline wrap" href="http://www.hmsa.com/portal/?gid=student&amp;pg=13" target="_blank">HMSA Student Portal</a> </p>
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          benefit.</span><br> <label style="color:Red">&nbsp; &nbsp; &nbsp;(NOTE: All J-1 visa holders are required by Federal Law to have repatriation coverage. <br> &nbsp; &nbsp; &nbsp; For UH, all international students are required by University
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          disabled="disabled">.</span><br>
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            parts A or B or SSDI.</label></span><br> <span id="container_ctl00_cphBody_cBody_lblNoPartAB" style="color:Red">&nbsp; &nbsp; &nbsp;(Note: In accordance with section 1882(d) of the Social Security Act, the University of <br> &nbsp; &nbsp;
          &nbsp; Hawaii/Chaminade Student plan is not available for individuals with Medicare coverage <br> &nbsp; &nbsp; &nbsp; (Part A or B or SSDI). Please contact HMSA at 808-948-6140 / toll-free 1-800-782-4672, if <br> &nbsp; &nbsp; &nbsp;
          further assistance is needed.)</span>
      </div>
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        <span id="container_ctl00_cphBody_cBody_lblDsplytxt"><br>Please be aware that your eligibility for the Student Plan is monitored throughout the semester(s).<br> Periodically HMSA and UH/Chaminade perform a recertification of eligibility which
          may occur<br> after the semester is already in progress. If UH/Chaminade is not able to confirm your eligibility,<br> HMSA will contact you to request a copy of your class schedule with credit hours.<br> If you are unable to furnish or do
          not have the appropriate number of credit hours<br> your coverage will be terminated retroactive back to the effective date of the semester.<br> All claims paid on your behalf will be deducted from your refund.</span>
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  <div id="legal">
    <a id="container_ctl00_hlNotice" href="Legal/LegalNotices.aspx" target="_blank">Legal Notices</a> | <a id="container_ctl00_hlTerms" href="Legal/TermsAndConditions.aspx" target="_blank">Terms &amp; Conditions</a> |
    <a id="container_ctl00_hlPrivacy" href="Legal/PrivacyStatement.aspx" target="_blank">Privacy Statement</a> | <a id="container_ctl00_hlEConsent" href="Legal/ElectronicEnrollmentConsent.aspx" target="_blank">Electronic Enrollment E-Consent</a>
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  <div id="copyright"> An Independent Licensee of the Blue Cross and Blue Shield Association<br> HMSA is licensed to use the Blue Cross and Blue Shield symbols in the state of Hawaii.<br> © 2022 Hawaii Medical Service Association All rights
    reserved.<br> Help with the online enrollment - <a style="color:white;" href="mailto:webmaster@hmsa.com">webmaster@hmsa.com</a>
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Text Content

HMSA’S UNIVERSITY OF HAWAII/CHAMINADE UNIVERSITY STUDENT PLAN ENROLLMENT



You must read and agree to, by checking, all of the notices listed below.


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:

HMSA Student Portal


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.)
You must select an application type. 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.

Legal Notices | Terms & Conditions | Privacy Statement | Electronic Enrollment
E-Consent
An Independent Licensee of the Blue Cross and Blue Shield Association
HMSA is licensed to use the Blue Cross and Blue Shield symbols in the state of
Hawaii.
© 2022 Hawaii Medical Service Association All rights reserved.
Help with the online enrollment - webmaster@hmsa.com