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Travel Assistance Request Form The referring physician should fill out sections B C Please fax completed form to 808 944-5600 Or Mail to HMSA / Medical Management Dept. P. O. Box 2001 Honolulu Hawaii 96805-2001 Phone No 808 948-6464 Oahu 800 344-6122 Neighbor Islands HSTA Travel Reimbursement Benefit Airfare Reimbursement Taxi Reimbursement Parent/Guardian for a minor CONTACT INFORMATION Any questions or concerns regarding this request may be dir.

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Customer Service: Calls to these numbers are free: Current members may call 1 (800) 776-4672. Prospective members may call 1 (800) 618-4672.

Submit the form and medical records to TPA. TPA will inspect all the documents. Once approved, the insurance company will settle the hospital bills, which excludes phone charges, attendant charges, food etc. In case of disapproval, one can file for reimbursement.

Financial and legal assistance Sometimes employees need financial or legal help and HMSA is standing by, ready to help. By providing debt consolidation and credit counseling, we help employees get back on track, giving them sound advice and hope for a more secure financial future.

Reimbursement Claim refers to the type of claim wherein an insured must pay for the medical costs and treatment out of their pocket and later claim the bill from the insurance provider. For this kind of claim, the insured can visit any hospital for treatment and not necessarily the empanelled cashless hospital.

HMSA members, except those covered by The HMSA Children's Plan, have benefits for medical services outside the U.S. through the BlueCard Worldwide network. All name changes must be submitted to HMSA as a signed request in writing with by documentation of the new name, such as a marriage certificate.

Most HMSA plans include air ambulance benefits for emergencies in which transportation is needed to the nearest hospital within the state of Hawaii.

You can print the Prescription Reimbursement Claim Form from My Account on hmsa.com. You can also request copies by mail or in person. Use the Prescription Reimbursement Claim Form to request reimbursement for prescription drugs. Your dental claims information is accessible online through My Account on hmsa.com.

Documents Required for Filing Reimbursement Claim Health Card Copy. Duly Filled Claim Form. Original Hospital Discharge Summary. Investigation Reports like scans, X-rays, blood reports, etc. Cash Receipts from Hospitals. If an accident happens, then FIR or medico-legal certificate(MLC)

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
Industries
Forms in Spanish
Localized Forms
State-specific Forms
Forms Kit
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232