Skip to Main Content

My Health Pays Rewards Program Form

MY HEALTH PAYS REWARDS SELF-ATTESTATION FORM

‘Ohana Health Plan is excited to offer you rewards for completing a 2025 My Health Pays activity. The activity must have happened between 1/1/25 - 12/31/25.
Please fill out the member info, check the box of the activity you completed, and press submit to process your reward. If you need help filling out the form online we are available to help you. Call Customer Service toll-free at 1-888-846-4262 (TTY: 711).

Member Information

My Health Pays Activity Rewards

The activity must have happened between 1/1/25 - 12/31/25. If you need more information about what rewards you can receive, visit the My Health Pays Rewards Program page..

 

Click the activity that you have completed:

Please Select

Update My Address and Contact Information

Please Select Option:

Annual Wellness Visit

Infant Well-Child Visit for 0-14 months old

Infant Well-Child Visit for 15-30 months old

Notification of Pregnancy

Are you currently seeing an OB for your pregnancy?

Postpartum Depression Screening Completed

I attest required *