Employees are eligible to waive coverage if they meet the requirements for waiving in Hawaii. An HC-5 form must be completed each plan year and will expire on December 31st of the current year.


Waiver Reasons

  • Federal Coverage: Covered by Medicare, Medicaid, or military/VA benefits. 
  • Dependent Coverage: Covered as a dependent on a spouse or parent's qualified plan. 
  • Public Assistance: Receiving state medical assistance like Med-QUEST. 
  • Religious Beliefs: Belonging to a recognized religious group relying on spiritual healing.

Proof of Coverage

Employees who complete the Hawaii waiver will also need to submit proof of other qualified coverage.

Waiver Form