Get Ohana Plus Program Application Form - Hawaii Life Flight

Filling out the Ohana Plus Program Application Form for Hawaii Life Flight online can streamline your application process. This guide provides clear steps to ensure that you accurately complete all sections of the form.

Follow the steps to successfully complete your application form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by entering the applicant’s name. Fill in the last name, first name, and middle initial in the designated fields.
3. Next, input the birth date using the format: month, day, and year. Ensure it is accurate as it is essential for identification.
4. Provide your mailing address, including number and street or P.O. Box, city, and zip code. This information is necessary for correspondence.
5. Include your home and alternate phone numbers, along with your email address for quick communication.
6. Indicate your current health insurance provider. If you have the Ohana Health Plan, please specify if your coverage is through Medicaid or Medicare.
7. List any family member names you wish to include, along with their birthdates in the same format.
8. Select the appropriate membership option by marking either 'Single or Family Membership with health insurance' or without health insurance. Provide payment of $30.00 or $60.00 respectively.
9. Choose your payment method by marking the corresponding option for a credit card (VISA, MasterCard, AMEX) or check/money order. If using a credit card, fill in the card number, expiration date, name on card, and CVC code.
10. Obtain and provide the signature of the cardholder, along with the date. Then, have the applicant or legal guardian sign and date the form.
11. If applicable, fill in the 'Member Referral Program' section by including the name of the member who referred you, as this might entitle them to additional membership benefits.
12. Complete the 'For Office Use Only' section if necessary, although it may be for the reviewing authority.
13. Finally, review all entries for accuracy before saving, downloading, printing, or sharing the completed form.

Complete your Ohana Plus Program Application Form online to ensure a smooth application process.