Follow the steps to complete the application accurately.

1. Click the ‘Get Form’ button to access the application and open it for editing.
2. Begin by entering your business information. Fill in the legal business name and indicate if it applies to the Hawaii Department of Labor’s employer registration and the DCCA’s business registration. If applicable, provide the name under which you operate (doing business as).
3. Provide your business address, including street address, city, state, and zip code. If you have a billing address that is different, complete those fields as well.
4. Enter the name of a contact person, their phone number (including area code), fax number, and email address for all correspondence regarding the application.
5. Select the type of business from the available options, such as corporation, partnership, sole proprietor, LLC, or other. Remember to provide your North American Industry Classification System (NAICS) number and Federal Tax Identification Number.
6. Indicate the department of labor number and the size of your employer based on the previous calendar year, counting full-time equivalents (FTEs) properly.
7. Answer whether those who own 50% or more of the business will be enrolled in HMAA’s plan, and if yes, confirm whether they are covered by Workers’ Compensation insurance, providing the name of the carrier if applicable.
8. Indicate the requested effective date of coverage, specifying the month and year.
9. Complete any COBRA and Medicare information, ensuring to submit any additional required documents indicated in this section.
10. Fill in broker information, if relevant, by providing the broker's name and agency details.
11. Review the certification and acknowledgment section. Confirm understanding of the terms regarding employee enrollment, accuracy of information, and obligations regarding changes.
12. Sign and date the application, entering the name of the group/employer and the title of the owner or authorized executive.
13. Complete the HMAA association application by signing and dating if applying for membership on behalf of your business.
14. Once all sections are completed, ensure to save your changes, and you may download, print, or share the completed form as needed.

Start filling out your HI HMAA Business Application online today to secure your business health coverage.