Forms and Documents

Questions? Contact Customer Services (808) 532-4000, or toll free 1 (800) 458-4600 8 a.m. - 5 p.m. Hawaii Standard Time Monday through Friday except holidays

Medical

Essential Health Benefits (EHB)

Prescription Drug

Drug Plan T
Drug Plan T
PDF Document

Vision

Dental For Large Groups (51 or more employees)

HDS $1000
HDS $1000
PDF Document
HDS $1500
HDS $1500
PDF Document

Dental For Small Groups (50 or less employees)

HDS $1000
HDS $1000
PDF Document
HDS $1000K
HDS $1000K
PDF Document
HDS $1500
HDS $1500
PDF Document
HDS N400
HDS N400
PDF Document

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