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 Employer Services

Don’t worry about lost or illegible forms–enroll your employees electronically! It’s secure and easy to use. Complete the Online Agreement Authorization and Certification 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 do not qualify for this coverage.

    • Dependent Disability Certification
      Submit if the member’s child is disabled.

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, submit COBRA Continuation Coverage Election Form)

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