Open Enrollment: October 15 to November 7, 2025 for 2026 plan year

• HMSA Annual (Open) Enrollment letter with rates for 2026
• ​Benefits At-a-Glance for 2026 (comparison guide)
• 2026 Summary of Benefits Med 734/Drg 860/Vis 0GA/Den C51 
• 2026 Summary of Benefits Med 735/Drg 860/Vis 0GA/Den C54
• 2026 Summary of Benefits Med Q-A/Drg 861/Vis 0HA/Den C51
• 2026 Summary of Benefits Med Q-A/Drg 861/Vis 0HA/Den C54
• 2026 Renewal Brochure
• 2026 Dental Flyer
• 2026 Vision Flyer
• 2026 Drug Flyer​
• For additional resources from HMSA, please visit their website HERE

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Documents for Employees

Documents below are available to be downloaded, you may click on the link to do so:

HMSA documents

• Application (an online form)
• Well-Being Guide
• Premiums Rates for plan year 2026
• Benefits At-a-Glance 2026
• We're Here For You Brochure
• HMSA's Online Care
• Behavioral Health Program
• My Account Guide
• Online Care Rack Card
• Travel with HMSA flyer
• HMSA Health Plan Hawaii Directory of Health Centers and Providers rev. 2025-10-27

ACA required documents for ELIGIBLE employees (even if they decline coverage)

• Healthcare Compliance Notices 2022
• No Surprises Act Notice
• Nondiscrimination Notice 
• ACA Model Cover Letter to Employees (ask your church for a copy)
• ACA Model Notice Health Plan (ask your church for a copy)
  
  

ONLY IF the employee is eligible, but declines health insurance​

• HC-5 Form for 2025
• HC-5 Form for 2026

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Documents for Employers to complete and then give to Employee(s)

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• ACA Model Cover Letter to employee
  • Copy and paste the ACA Model Cover Letter to Employees to your church's letterhead, make appropriate changes, sign, and give to the employee.
• ACA Model Notice Health Plan
  • Complete yellow highlighted question 13.