Forms & Resources

Hawaii

• HMSA Essential Prescription Formulary
• 2022 HMSA Prescription Drug Rider
• 2023 HMSA Medical Guide to Benefits
• 2020 SBC Addendum (COVID-19)

Medical Spending Accounts

• FSA Claim Form
• Managing Your HSA: Helpful Online Tools

Prescription

• CVS Caremark Mail Service Order Form
• Caremark RX Claim Form
• 2025 CVS Performance Drug List
• ACA Preventive Services Drug List
• HDHP Generics Preventive Drugs List
• Mandatory Maintenance Choice

Caregiving

• • Homethrive Resources

SaveSmart 401(k) & Retirement

• 401(k) Rollover Form
• SaveSmart 401(k) Summary Plan Description
• Long-Term Cash Retirement Provision

Work or Life Changes

• 2025 Benefits at Separation
• FAQ for Full-Time and Part-Time
• How to Submit a Claim for STD/LTD

Adoption Assistance Program

• Adoption Assistance Reimbursement Form

Tuition Assistance Program

• Tuition Assistance Program Application

Legal Notices

• Children’s Health Insurance Program (CHIP) Notice
• HIPAA Notice
• Medicare Part D Notice
• SmartChoices Summary Plan Description
• Summary Annual Report
• SaveSmart 401(k) Summary Plan Description
• 2025 Illinois Medical Coverage Disclosure
• Surprise Billing Model Notice
• Transparency in Coverage – Machine Readable Files (MRFs)

New York Notices

• New York Workplace Poster
• New York Paid Family Leave Notice
• New York Disability Notice
• New York Policy on Paid Breaks to Express Milk
• New York Prenatal Frequently Asked Questions