UHA Employer Online Application:


Welcome to UHA's online Employer Application submission system. It should take about 15 minutes to complete your application if you have the necessary information.

Please select if you are a Small or Large Group and then click the "Continue" button below to start this application process.

Small Group - In Hawaii, a Small Group is any employer with 50 or fewer full-time employees. UHA requires that that employer groups have a valid Department of Labor number.
Large Group - In Hawaii, a Large Group is any employer with 51 or more full-time employees.

Your application information will be electronically submitted to UHA Health Insurance's Sales Department and a representative will contact you shortly.

Please click here to download and submit a paper application. Please call (808) 532-4009 should you have questions or would like to speak with a representative.

Your online application session will time out after an extended period of time. The following code will enable you to resume where you left off should your browser get interrupted or time out. Please write down your Code 3XGA3P should you need to resume your session at a later time. Codes are good for 7 days.

If you are resuming a previous session, please enter the code you were given at that time and click Resume.

Please select Group Size on the Instructions tab.

Please select Group Size on the Instructions tab.

Attestation: I certify that the information submitted in this application is accurate and complete.

Please check the affirmation box and type your name as your digital signature for this form. Enter your contact information and click Submit Application.




Upon submit, a copy of your application will be sent to this address.

Your application information will be electronically submitted to UHA Health Insurance's Sales Department and a representative will contact you shortly.