<DATE>
<NAME1>
<NAME2>
<ADDRESS1>
<ADDRESS2>
<CITY> <STATE> <ZIP CODE>
Dear Provider:
In order to provide you with the most efficient and cost-effective communications as well as going
“green”, HMSA is hoping to expand its ability to communicate with you via email.
Please find the enclosed agreement to receive electronic communications from HMSA. If you are
interested in joining us in this effort and to receive communications via email and to communicate
with HMSA electronically, please complete, sign, and return the form using the enclosed selfaddressed envelope. In doing so, this will apply across all contracts and constitute a change to your
original contract.
We appreciate your participation in HMSA's plans and look forward to receiving your signed form. If
you have any questions, please call 948-5190 on Oahu or 1 (800) 603-4672, ext. 5190, toll-free on
the Neighbor Islands. You may also email us at [email protected].
Sincerely,
Paul K. Schnur
Vice President
Provider Services & Contracting
Enclosures
1182-0260
Hawai‘i Medical Service Association
818 Keeaumoku St.• P.O. Box 860
Internet address
Honolulu, HI 96808-0860
www.HMSA.com
(808) 948-5110
Branch offices located on
Hawaii, Kauai, and Maui