Hawaii hc 5 2025

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The document is a notification form (Form HC-5) from the Hawaii Department of Labor and Industrial Relations for employees to inform their employers about health care coverage status for the calendar year 2015. It outlines conditions under which the form should be used, such as working for multiple employers or claiming exemptions from health care coverage. The form requires employees to indicate their principal employer, any exemptions, or waivers related to health care coverage, and provides instructions for both employees and employers regarding the handling of the form.

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Click ‘Get Form’ to open the Hawaii HC-5 in the editor.
Begin by entering your employer's name and DOL account number in the designated fields. Ensure accuracy as this information is crucial for processing.
Fill in your address and telephone number. This helps maintain clear communication with your employer regarding health care coverage.
Select the appropriate box that applies to your employment situation, indicating whether you are designating a principal or secondary employer, claiming an exemption, or waiving coverage.
If applicable, provide details about your alternative health care plan in the waiver section. Clearly state the name of the plan and contractor.
Print your name, sign the form, and include your address and phone number again for verification purposes.
Finally, save a copy of the completed form for yourself before submitting it to your employer.

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Versions	Form popularity	Fillable & printable
2015	4.9 Satisfied (341 Votes)
2014	4.4 Satisfied (53 Votes)

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We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How much can an employer charge an employee for health insurance in Hawaii?

How much of the premium does the employer have to pay on behalf on an employee? At least one-half of the premium as long as the employee contributes no more than 1.5% of their wages towards the premium.

How to fill out form HC-5?

To fill out the HC-5 form, you will need to provide specific information about your employment status and health care coverage. Carefully check the appropriate boxes to indicate your employment situation and health care exemptions. Ensure to sign and date the form before submission.

How do you qualify for TDI in Hawaii?

To be eligible for TDI benefits, an employee must have at least 14 weeks of Hawaii employment during each of which the employee was paid for 20 hours or more and earned not less than $400 in the 52 weeks preceding the first day of disability. The 14 weeks need not be consecutive nor with only one employer.

What is an HC-5 form in Hawaii?

Hawaii Form HC 5 is an application for Hawaii health insurance coverage. The form is used to apply for health coverage under the Hawaii Prepaid Health Care Act, which requires employers to provide health insurance coverage to their employees.

Does Hawaii have paid sick leave?

Does Hawaii Have Paid Sick Leave Laws That Differ from Federal Paid Sick Leave Laws? There is no law in place in Hawaii that requires private employers to provide paid or unpaid sick leave to employees.

state of hawaii hc 5

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What is the pre paid health care act in Hawaii?

How Does the Hawaii Prepaid Health Care Act Work? The Hawaii Prepaid Health Care Act requires employers to provide approved, suitable health care coverage to employees who work at least 20 hours a week for a minimum of four consecutive weeks.

What is a WC 5 form in Hawaii?

WC-5 Employees Claim for Workers Compensation.