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  • Member Enrollment Form - Uha

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MEMBER ENROLLMENT FORM Page 1 of 2 REASON FOR ENROLLMENT 1 (One Selection Only) Open Enrollment Add a new subscriber (with or without family) Reinstate Subscriber (no break in coverage) Add Dependent(s).

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UHA will cover all eligible dependent children up until their 26th birthday. If an employee's dependent is certified as disabled, the dependent may continue coverage after UHA has reviewed and approved enrollment of a completed Disability Certification Form.

In 1996, a group of physician teachers at the University of Hawaii John A. Burns School of Medicine decided to make a difference. They created the University Health Alliance to bring a simpler, more caring approach to employee health insurance. Since then, UHA has grown to offer the largest physician network in Hawaii.

Can I have my own insurance and be on my parent's policy at the same time? Yes, you can have your own health insurance plan while staying on your parents' policy.

UHA 600 (Bundle) No annual deductible and UHA covers 90% of the cost of physician services.

To answer the primary question, no, individuals who are not family members do not qualify as dependents. In general, you may only add an individual to your insurance plan if you are related by blood, marriage, or adoption.

UHA 3000 – Focused on Keeping You Well. UHA offers Hawaii's first health insurance plan to offer full, complete, 100% coverage for wellness and preventive medicine. Our plans provide services that help keep you healthy, detect diseases early, and prevent chronic disease at no cost to you.

There are three ways to submit medical claims electronically. You may connect either directly to UHA, submit your claims through a clearinghouse that has a connection with UHA, or through the Hawaii Xchange online service.

UHA's healthcare network is within the state of Hawaii only. You will pay substantially more for services you receive on the Mainland if the service can be done in Hawaii.

UHA offers a Preferred Provider Organization (PPO) plan that provides the state's top comprehensive medical benefits, paying at 90% of the eligible charge for most services rendered by a participating provider.

Can my domestic partner be added to my benefits? Yes.

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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