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Hmsa travel request form 2025

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The document is a Travel Assistance Request Form for HSTA members, outlining the process for requesting travel reimbursement for medical services not available on the island. It includes sections for member information, diagnosis codes, procedure details, provider information, and reasons for referral. The form must be completed by the referring physician and submitted via fax or mail to HMSA's Medical Management Department.

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Who should fill out sections B & C of the Travel Assistance Request Form?

The referring physician should fill out sections B & C.

Where should I send the completed Travel Assistance Request Form?

You can fax it to (808) 944-5600 or mail it to HMSA / Medical Management Dept., P. O. Box 2001, Honolulu, Hawaii 96805-2001.

What is the contact number for questions regarding the request?

You can call (808) 948-6464 for Oahu or (800) 344-6122 for Neighbor Islands.

What information is required in section A of the form?

Section A requires member information including membership number, patient’s name, companion’s name if applicable, date of birth, and daytime phone number.

What types of reimbursements are available through HSTA?

HSTA offers airfare reimbursement and taxi reimbursement.

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Does HMSA cover travel expenses?

HMSA provides help with travel between islands for non-emergency medical care if you meet certain criteria. Find out if you qualify for HSTA travel reimbursement by filling out this form.

What is the purpose of a reimbursement form?

A reimbursement is when an employer compensates an employee for a work-related expense the employee paid for out of pocket. And a reimbursement form is a document the employee submits to the employer to request the compensation.

How to fill a travel request form?

A typical travel request form includes: Employee information: Name, department, and contact information. Travel details: Destination, purpose of the visit, departure and return dates. Transportation and accommodation: Preferences or arrangements for flights, hotels, car hire, etc.

How do I request reimbursement from HMSA?

To submit a drug claim to HMSA, you must complete the Prescription Reimbursement Claim Form and mail it to HMSAs pharmacy benefit manager. Our pharmacy benefit manager will review and process your claim ing to your HMSA plan benefits.

What counts as travel reimbursement?

However, under IRS rules, reimbursement of travel expenses generally is taxable to the employee where an employer reimburses the employee for travel expenses (other than transportation expenses between work locations) incurred while the employee is in the vicinity of his or her tax home.