Get Hawaii Rx Plus Program Application - Department Of ... - Med-quest

The HAWAII Rx PLUS PROGRAM APPLICATION is an essential document for individuals seeking assistance with prescription drug costs. This guide provides clear and supportive instructions on how to accurately complete the application online, ensuring you have the necessary information to proceed smoothly.

Follow the steps to complete your application effectively.

1. Press the ‘Get Form’ button to access the application form and open it in your editor.
2. Fill in your personal information in Section 1. Include your last name, first name, middle initial, address, and contact details. Make sure to provide both daytime and nighttime phone numbers along with your email address.
3. In Section 2, list yourself as the first person and provide information about your household members. Enter their legal names and relationships to you. Ensure to indicate if each person is a resident of Hawaii and if their medication costs are covered by insurance.
4. Complete Section 3 by reporting all income received by your household in the past twelve months. This includes wages, benefits, and any other financial assistance.
5. In Section 4, sign and date the form to certify that the information provided is accurate to the best of your knowledge. Ensure that if you are completing the application for another individual aged 18 or older, you have their authorization.
6. Review all provided information for accuracy before submitting the application. Make any necessary edits.
7. Save your changes and download, print, or share the completed application form as needed.

Take the next step and complete your application online!