Hc-5 Form 2025

Hc-5 Form 2025 – The employer retains the original and gives a copy to the employee. Ask your employer for a claim form or contact us if your employer does not have the claim form. This form is for employees who work at least 20 hours per week and have multiple employers or health care coverage options in hawaii. Industrial relations, employee benefits, health insurance form, hawaii legal forms, legal and united states legal forms.

You will not be able to roll over any unused funds to the following plan year. Use this form to notify your employer of your health care coverage status for 2025 under the hawaii prepaid health care act. Your cost of coverage has. Employers should follow up with all employees who previously waived coverage, provide a.

Choose your employer designation, exemption, waiver, or plan name and submit to the department of labor and industrial relations. Those covered by a federally established health insurance or prepaid health care plan, such as medicare, medicaid or medical care benefits provided for military dependents and military retirees and their dependents; The employer sends a copy to.

Fill out this online form to notify your employer of your health care coverage status for 2025. Claim forms are not available online. Find information about health insurance plans, rates, benefits, and enrollment for 2025 plan year.

Check the appropriate box for your situation and follow the instructions for completion and submission. It notifies the employer of the employee’s selection and the employer’s responsibility under the hawaii prepaid health care act. Download free pdf viewer from adobe to access the forms online.

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