New Member Enrollment Form

Effective October 1, 2023

The subscriber’s signature is no longer required unless the subscriber is under the age of 18 years old. If the subscriber is under the age of 18, the parent/guardian signature is also required.  Forms not meeting this requirement will be returned.

UHA will continue to accept the previous version of the UHA Member Enrollment form until December 31, 2023, however, the form must be signed by the subscriber. Any forms that are missing the subscriber’s signature will be returned.

You may find a copy of the new Member Enrollment Form on our website:  uhahealth.com/enrollmentform

Should you have any questions, please contact Employer Services.

Phone: (808) 532-4007; Toll-free phone: (800) 458-4600 Ext. 299; [email protected]