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

2025 Drug Plan T
2025 Drug Plan T
PDF Document
2024 Drug Plan T
2024 Drug Plan T
PDF Document

Vision

Dental For Large Groups (51 or more employees)

2025 HDS $1000
2025 HDS $1000
PDF Document
2024 HDS $1000
2024 HDS $1000
PDF Document
2025 HDS $1500
2025 HDS $1500
PDF Document
2024 HDS $1500
2024 HDS $1500
PDF Document

Dental For Small Groups (50 or less employees)

2025 HDS $1000
2025 HDS $1000
PDF Document
2024 HDS $1000
2024 HDS $1000
PDF Document
2025 HDS $1000K
2025 HDS $1000K
PDF Document
2024 HDS $1000K
2024 HDS $1000K
PDF Document
2025 HDS $1500
2025 HDS $1500
PDF Document
2024 HDS $1500
2024 HDS $1500
PDF Document
2025 HDS N400
2025 HDS N400
PDF Document
2024 HDS N400
2024 HDS N400
PDF Document

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