Form HC-5 Employee Notification to Employer - Hawaii

What Is Form HC-5?

This is a legal form that was released by the Hawaii Department of Labor & Industrial Relations - a government authority operating within Hawaii. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form HC-5?
A: Form HC-5 is the Employee Notification to Employer form in Hawaii.

Q: What is the purpose of Form HC-5?
A: The purpose of Form HC-5 is to notify your employer about your decision to opt out of the Hawaii Prepaid Health Care Act.

Q: Who needs to fill out Form HC-5?
A: Employees in Hawaii who wish to opt out of the Hawaii Prepaid Health Care Act need to fill out Form HC-5.

Q: When do I need to submit Form HC-5?
A: You should submit Form HC-5 to your employer within 20 days of your employment start date.

Q: Can I change my mind after submitting Form HC-5?
A: Yes, you can change your mind and opt back into the Hawaii Prepaid Health Care Act. Contact your employer for further instructions.

Q: What happens if I don't submit Form HC-5?
A: If you do not submit Form HC-5, you will be automatically enrolled in the Hawaii Prepaid Health Care Act and your employer will deduct the required premiums from your wages.

Q: Is there a deadline to submit Form HC-5?
A: Yes, you must submit Form HC-5 within 20 days of your employment start date.

Q: What if I have more questions about Form HC-5?
A: If you have more questions about Form HC-5 or the Hawaii Prepaid Health Care Act, you can contact the Hawaii Department of Labor and Industrial Relations for assistance.