The 2023 Form HC-5 (Employee Notification to Employer) is available online at the Hawaii Department of Labor and Industrial Relations (DLIR) website. Use this form if the employee works at least 20 hours per week and:
To download the form, visit the DLIR site. https://labor.hawaii.gov/dcd/files/2022/09/HC-5-2023.pdf
For more information on Prepaid Health Care in Hawaii, visit the DLIR PHC FAQ page.