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  • Aloha Care Drug Coverage Form

Get Aloha Care Drug Coverage Form

Print Form DRUG COVERAGE REQUEST FORM Strength: QUEST and Medicare Pharmacy Services Fax #: 973-6327, Toll-Free Fax (877)-316-6376 MEMBER INFORMATION Name: Member ID #: D.O.B.: PROVIDER INFORMATION.

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AlohaCare | 1357 Kapiolani Blvd., Suite 1250 Honolulu, HI 96814. (808) 973-0690.

Take your AlohaCare member ID card with you when you travel to the Mainland, in case you need it. Emergency care is covered outside of Hawaii. Non-emergency care is not covered outside of Hawaii.

Call Member Services at 808-973-0712 (O`ahu) or toll-free at 1-877-973-0712. If you require assistance due to a hearing impairment, call 1-877-447-5990.

Deductible – This plan does not have a deductible. Cost Sharing – You will have no cost sharing responsibility for Medicare-covered Part A and B services, based on your level of Medicaid eligibility.

To enroll into AlohaCare Advantage Plus: You must be a resident of Hawaii. You have full benefit Medicaid coverage. You must have Medicare Parts A and B. You must continue to pay for your Medicare Part B premium. The State pays the Part B premium for full-dual members who are eligible for AlohaCare Advantage Plus.

AlohaCare is a health plan with a Medicare contract and provides Medicare coverage to beneficiaries in Hawaii.

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© Copyright 1997-2025
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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
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
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