2025 Hc-5 Form – The employee's selection below is applicable only within calendar year 2025. Use this form if you work for at least 20 hours per week and: For 2025, you can elect to contribute up to $5,000. **the principal employer is the employer who pays the employee the most wages.

Employees waiving coverage must complete this form by december 31, 2025. 7+,6 6(&7,21 ,6 )25 7+( (03/2<(5 72 &203/(7( *lyh d frs\ ri wklv frpsohwhg irup wr wkh hpsor\hh.hhs wklv frpsohwhg vljqhg irup rq iloh iru \hduv 7,i wkh hpsor\hh zloo eh uhqhzlqj wkh vhohfwlrq diwhu kdyh wkh hpsor\hh frpsohwh wkh irup iru wkh dssursuldwh \hdu. Documents for employers to complete and then give to employee(s). Ask your employer for a claim form or contact us if your employer does not have the claim form.

2025 Hc-5 Form

2025 Hc-5 Form

Claim forms are not available online. Employers should follow up with all employees who previously waived coverage, provide a. If the employee will be renewing the selection after 2025, have the employee complete the form for the appropriate year.

Contact your phc plan contractor for information. Originating from the department of labor and industrial relations, this form facilitates a unique aspect of hawaii’s labor laws, aiming to ensure that individuals have. Your cost of coverage has.

Industrial relations, employee benefits, health insurance form, hawaii legal forms, legal and united states legal forms.

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