KOLEA

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Account Holder Details

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This account will help you apply for and manage your health coverage over time. We are
committed to protecting your personal information.

Required fields are marked with an asterisk(*).

FIRST NAME*

LAST NAME*

EMAIL*

RE-ENTER EMAIL*

USER NAME*

PASSWORD*

RE-ENTER PASSWORD*

SECURITY QUESTION*

YOUR ANSWER*

SECURITY QUESTION*

YOUR ANSWER*

SECURITY QUESTION*

YOUR ANSWER*

Are you registering as a Navigator or Kokua?*
A Navigator or Kokua is someone who is authorized by the State of Hawaii
to assist others to apply for benefits. Navigators and Kokua must be approved,
certified and trained by the State of Hawaii before an application can be entered.

Yes No

If you are looking to buy health insurance without assistance, please visit the Federal Health Insurance Marketplace site at www.healthcare.gov