Enroll Your Employees

After you have accepted your customized rate proposal quote along with your employee's health benefit plans, the next step is to enroll your employees.

Online Enrollment Services

Don't worry about lost or illegible forms--enroll your employees electronically! It's secure, easy to use, and saves paper. Complete the Online Agreement Authorization Form or contact UHA Employer Services at (808) 532-4007, or toll free at 1-800-458-4600, extension 299 for more information.

Enrollment Forms

Requests for enrollment are only accepted during qualifying enrollment events. View the list of qualifying events.

• Member Enrollment form
  Submit for all regular employees within 31 days of the date the employee becomes eligible for coverage. Employees' spouses, dependent children to age 26 regardless of marital status, enrollment in school, or residency or disabled children are also eligible to be enrolled.
  Please note: Spouses and children of adult dependents and adult dependents who are eligible for coverage through their employer do not qualify for this coverage.
• Dependent Disability Certification
  Submit if the member's child is disabled
• Adult Dependent Declaration Status Form
  This declaration is required to enroll new dependents beginning June 1, 2010, who are beyond the age of 18, up to age 26. COVERAGE FOR ALL EXISTING DEPENDENTS WILL BE AUTOMATICALLY EXTENDED UP TO AGE 26, PLEASE CONTACT YOUR EMPLOYER REGARDING DEPENDENT COVERAGE EXTENSION. You are not required to submit this form to UHA. However, you should keep this form in the event that UHA requests an eligibility audit.

Medical Benefits Guide

Once we have received and processed your enrollment forms, please provide those enrolled employees (members) with the Medical Benefits Guide (MBG) that corresponds to their health plan.

Member ID cards

Enrolled members will be provided with a member ID card which shows their plan information and group, division and unique member ID numbers. It is important that members keep this card with them, and present it to their health care provider at the time of service.

Members that are enrolling in drug plans will also be receiving a prescription ID card in the mail from UHA's pharmacy benefit manager. They will be expected to present this prescription ID card at the pharmacy to verify eligibility for prescription coverage.

We are striving to make enrolling your employees more convenient. Contact Information Services to discuss creating Electronic Enrollment and Maintenance (EEM) transactions.

Manage Your Enrollment

Managing your members is just as easy as enrolling. Most changes in enrollment are only accepted during qualifying enrollment events. View the list of qualifying events.

• Member Change form
  Submit if there are changes to a members' name, address, phone number, or transferring a member to a different division.
• Member Termination form
  Member eligibility terminates on the last day of the month even if the employee was not employed up to the last day of the month. Mid-month terminations are not allowed, and retroactive terminations for prior months will not be accepted. (For COBRA services, click here)

Eligibility changes will be effective on the first of the month, following receipt of the appropriate form(s). Newborn eligibility begins from date of birth, if the Member Change form is received by UHA within 31 days from the newborn's date of birth.

For more comprehensive information on eligibility and enrollment procedures, please refer to the Group Administrator's Handbook.

The forms and documents on this page require the free Adobe Acrobat Reader, version 7.0 or above. Please download it here