News & Announcements

DLIR makes 2014 HC-5 Form Available

Published Thursday, December 26, 2013 1:28 pm



Companies with employees who waived medical coverage in 2013 will need to follow up with these employees to determine if they intend to waive coverage in 2014.  Where employees intend to waive coverage in the New Year, they should indicate as such on the 2014 HC-5 waiver form.  The waiver must be completed in triplicate, with one copy to the Disability Compensation Division, one copy to the employee signing the waiver, and one copy for company files.  2014 HC-5 Waiver

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