The State of Hawaii Department of Labor and Industrial Relations published the Form HC-5 for 2025, which is also available on the Disability Compensation Division’s Forms website.

Employees waiving coverage must complete this form on an annual basis. Employers should follow up with all employees who previously waived coverage, provide a copy of the signed Form HC-5 to the employee, and retain the original Form HC-5 for two years.

As a reminder, under Hawaii’s Prepaid Healthcare Act, covered employers must provide health care coverage to employees who work at least twenty hours per week after four consecutive weeks and earn at least 86.67 times the current Hawaii minimum wage per month ($14 per hour x 86.67 = $1,213.38). Eligible employees may waive mandated coverage by completing the Form HC-5 (Employee Notification to Employer) every calendar year, if certain situations apply, including: 

• Being covered by a federally established health insurance (e.g., Medicare or Medicaid); 
• Being covered as a dependent by a qualified plan (e.g., under a spouse's or parent's plan); 
• Being a recipient of public assistance and covered by a state-legislated health plan; 
• Being covered by their own personal health insurance policy; or 
• Being a follower of a religious group that depends on prayer or other spiritual means for healing. 

If you have any questions regarding Hawaii’s Prepaid Health Care Act or Form HC-5, please contact your HR Consultant.  

Please note the information provided is for informational purposes only and may not reflect the most current regulatory developments.  We strive to keep our materials up to date, but there may be occasions when information becomes outdated.  Users are encouraged to verify the applicability of the content before relying on it for decision-making.  If you have any questions or concerns regarding the accuracy or relevance of the information, please contact us directly for assistance.