Hawaii health plan manual 2026

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  1. Click ‘Get Form’ to open the Hawaii Health Plan Manual in our platform.
  2. Begin by reviewing the Preface section, which outlines the document's purpose and intended users. This will help you understand the context of the information provided.
  3. Navigate to Section 2, which covers Enrollment and Capitation Transactions. Here, you will find detailed instructions on how to complete enrollment forms, including necessary data fields such as eligibility dates and transaction types.
  4. In Section 3, familiarize yourself with Technical Infrastructure and Procedures. This section provides essential information about file transfers and communication requirements that may be relevant for your submissions.
  5. As you fill out specific fields in the form, refer to Appendix B for Codes and Values. This appendix includes critical codes related to ethnicity, primary language, and relationship codes that may be required in your entries.
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You may be eligible for QUEST (Medicaid) if: Youre 19 or older with a total household income at or below 138% of the federal poverty level (for example, $24,826 for a single person or $51,032 for a family of 4 in 2025)
We have year-round sun, surf, and the Hawaii Prepaid Health Care Act. This 1974 state law requires private employers in the state to provide approved health insurance for their employees who work at least 20 hours per week for four weeks in a row.
Your five choices for a QUEST Integration health plan are: Health PlansPhone/Website AlohaCare 1-877-973-0712 .alohacare.org HMSA 1-800-440-0640 .hmsa.com/QUEST Kaiser Permanente 1-800-651-2237 kpquest.org Ohana Health Plan 1-888-846-4262 .ohanahealthplan.com1 more row
Heart disease, cancer, and cerebrovascular diseases were the leading causes of death in Hawaii in 2022. Of the 6,381 deaths that year, 48% were due to one of these three causes. The fourth and fifth most common causes were accidents and Alzheimer disease.
Headquartered on Oahu with centers statewide to serve our members, HMSA is an independent licensee of the Blue Cross and Blue Shield Association.

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On January 1, 2006, AlohaCare commenced a Medicare Parts A, B and D risk-based contract with CMS that provides for inpatient, outpatient and prescription drug benefits based on Medicare regulations.

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