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HC5 (Rev.09/22)STATE OF HAWAII DEPARTMENT OF LABOR AND INDUSTRIAL RELATIONS DISABILITY COMPENSATION DIVISION Princess Keelikolani Building, 830 Punch bowl Street, Room 209, Honolulu, Hawaii 96813FORM

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How to fill out form hc-5 employee notification

01

Step 1: Obtain a copy of form HC-5 employee notification.

02

Step 2: Fill out the employee's personal information such as name, address, and social security number.

03

Step 3: Indicate the type of coverage the employee is requesting, such as medical, dental, or vision.

04

Step 4: Provide any additional information or documentation required by the form.

05

Step 5: Review the completed form for accuracy and completeness before submitting.

Who needs form hc-5 employee notification?

01

Employees who want to notify their employer about their health coverage choices.

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What is form hc-5 employee notification?

Form HC-5 employee notification is a document used to notify employees of their health coverage options.

Who is required to file form hc-5 employee notification?

Employers with group health plans are required to file form HC-5 employee notification for their employees.

How to fill out form hc-5 employee notification?

Form HC-5 employee notification can be filled out online or by mail. Employers need to provide information about the health coverage options available to their employees.

What is the purpose of form hc-5 employee notification?

The purpose of form HC-5 employee notification is to inform employees about their health coverage options and rights.

What information must be reported on form hc-5 employee notification?

Form HC-5 employee notification must include information about the health coverage options available to employees, including information about costs and coverage.

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