2026 Hawaii Form HC-5: What Employers Should Verify Before a WIMPER ProForma

For a Hawaii employer, a headcount is not always the same as a health coverage count. An employee may work for multiple employers, have qualifying coverage through another source, receive public assistance, or request an individual waiver under Hawaii’s Prepaid Health Care Act.

Hawaii Form HC-5 documents those situations. The Hawaii Department of Labor and Industrial Relations form page lists a calendar-year 2026 edition titled Employee Notification to Employer.

HC-5 is not a WIMPER enrollment form, and it does not determine eligibility for a Section 125 or Section 105 plan. It is a Hawaii state coverage record. Before a WIMPER ProForma, however, current HC-5 records can help an employer explain why its total W-2 headcount, health plan enrollment, and preliminary program population do not match.

1. Confirm that the employee should use HC-5

The 2026 Form HC-5 says it is for an employee who works at least 20 hours per week and does one of the following:

• Works for two or more employers
• Claims an exemption or waiver from health care coverage
• Terminates a prior exemption
• Changes a principal or secondary employer designation

The form also says not to use it when the employee works for only one employer and that employer provides health care coverage, or when the employee works fewer than 20 hours per week for that employer.

That instruction is a starting point, not a complete employee-specific eligibility decision. Employers should use current DLIR guidance and obtain qualified advice when the facts are uncertain.

2. Separate principal-employer records from exemption records

HC-5 handles more than one issue. Mixing the categories together can distort an employee census.

For concurrent employment, Hawaii Revised Statutes section 393-6 generally identifies the principal employer as the employer paying the most wages. If an employer that does not pay the most wages employs the person for at least 35 hours per week, the employee chooses the principal employer. The other employers are secondary employers.

The 2026 form provides separate selections for the principal and secondary employer. A secondary-employer designation is not the same as an exemption based on other health coverage.

Create distinct census fields for:

• Principal employer
• Secondary employer
• Federal-plan coverage exemption
• Dependent-coverage exemption
• Public-assistance or state-plan exemption
• Religious exemption
• Individual waiver
• Termination of a prior exemption or waiver

This makes the record reviewable instead of reducing every situation to a single “waived” label.

3. Verify the reason against the form, not memory

The 2026 HC-5 lists specific exemption categories. They include coverage through a federally established plan such as Medicare or Medicaid, coverage as a dependent under a qualified health care plan, public assistance or a state-legislated medical assistance plan, and a qualifying religious basis.

The statutory framework is also specific. HRS section 393-17 addresses federal-plan coverage, dependent coverage, and public assistance or state medical assistance. HRS section 393-22 addresses followers of certain teachings or beliefs who depend on prayer or other spiritual means for healing.

An individual waiver is a different path. Under HRS section 393-21, an employee requests the waiver in writing, and approval depends on the employee having other coverage under a prepaid health care plan that meets the required standards. The employer transmits the prescribed form and a copy of the plan supporting the request to the director.

Do not select a category for the employee or encourage a waiver to improve a projection. DLIR’s June 2026 highlights state that an employer is prohibited from coercing or attempting to coerce an employee to waive coverage.

4. Use the 2026 form for the 2026 calendar year

The form states that the employee’s selection applies only within calendar year 2026. If the selection will continue after 2026, the employee must complete the form for the appropriate later year.

DLIR’s June 2026 Highlights of the Hawaii Prepaid Health Care Law says the exemption or waiver notification is binding for one year and must be renewed every December 31.

Before using a census for a ProForma, check:

1. Is the HC-5 the edition for the current calendar year?
2. Is the employee’s selection complete?
3. Is the form signed and dated?
4. Has a change in coverage or employment made the selection stale?
5. Is renewal needed for the next calendar year?

A prior-year form should not silently carry forward as if it were current.

5. Retain the signed record and give the employee a copy

The employer section of the 2026 form instructs the employer to give the employee a copy and keep the completed, signed form on file for two years.

The June 2026 DLIR highlights add a filing distinction: the employer retains the original and sends a copy to DLIR when the employee selects individual waiver item 4, or when the director requests it. For item 4, the form instructs the employee to submit a copy of the supporting plan to the employer for forwarding to DLIR with the form.

A practical file check should confirm:

• The employer has the signed original
• The employee received a copy
• The retention date is recorded
• Item 4 submissions include the supporting plan copy
• Any required DLIR transmission is documented
• Access is limited because the file contains personal coverage information

Employers should confirm current submission procedures with DLIR rather than relying on an old internal checklist.

6. Reconcile changes before relying on the census

An HC-5 can stop matching reality. An employee may lose dependent coverage, leave a second job, gain Medicare coverage, or change which concurrent employer is principal.

HRS section 393-18 says an employee should promptly notify the principal employer when a claimed exemption terminates. It also addresses notice when a principal employer becomes secondary or a secondary employer becomes principal.

Compare the form with current payroll and benefits records. Flag any mismatch for review instead of assuming the older selection remains valid.

7. Keep three population counts separate for the ProForma

Before requesting a ProForma, build three clearly labeled counts:

1. Total W-2 population. The employer’s current employee census.
2. Hawaii health coverage population. Employees currently enrolled, documented as principal-employer responsibilities, or supported by current HC-5 records.
3. Preliminary WIMPER review population. Employees included for an initial fit analysis under the proposed plan terms and actual payroll facts.

These numbers may differ. HC-5 documentation can explain part of the difference, but it does not decide Section 125 or Section 105 participation. The WIMPER program is employer-owned and employer-run, and fit depends on plan design, payroll setup, employee participation, existing coverage, and professional review.

Bring the reconciled counts, current HC-5 records, payroll census, health plan enrollment, and existing Section 125 documents to the review. The broader WIMPER Hawaii ProForma preparation checklist identifies the other records that may be useful. Employers can also review the WIMPER program overview and frequently asked questions.

If you are a Hawaii employer and want to see whether this structure fits your payroll and coverage setup, request a ProForma based on your actual data.

References

1. Hawaii Department of Labor and Industrial Relations, Disability Compensation Division, Forms. Used to verify the listed 2026 HC-5 edition.
2. Hawaii Department of Labor and Industrial Relations, Disability Compensation Division, Form HC-5, Employee Notification to Employer for Calendar Year 2026. Used for form purpose, selections, calendar-year limitation, employer copy, two-year retention, and item 4 supporting-plan instructions.
3. Hawaii Department of Labor and Industrial Relations, Disability Compensation Division, Highlights of the Hawaii Prepaid Health Care Law, revised June 2026. Used for HC-5 retention, DLIR transmission, annual renewal, anti-coercion, and concurrent-employment guidance.
4. Hawaii State Legislature, HRS section 393-6, Principal and secondary employer defined. Used for principal-employer designation and anti-coercion rules.
5. Hawaii State Legislature, HRS section 393-17, Exemption of certain employees. Used for statutory exemption categories.
6. Hawaii State Legislature, HRS section 393-18, Termination of exemption. Used for change-notification requirements.
7. Hawaii State Legislature, HRS section 393-21, Individual waivers. Used for waiver request, approval, transmission, renewal, and anti-coercion requirements.
8. Hawaii State Legislature, HRS section 393-22, Exemption of followers of certain teachings or beliefs. Used for the religious exemption framework.

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This article was drafted by A.I. and is subject to human review before publication.

This article provides general educational information, not legal, tax, payroll, benefits, or plan-administration advice. It does not determine an employee’s rights, coverage status, exemption, waiver, or eligibility under the Hawaii Prepaid Health Care Act or any Section 125 or Section 105 plan. Employers and employees should confirm current requirements with DLIR and qualified legal, tax, payroll, and benefits professionals before acting.

For a correction, credit change, or removal request concerning a cited source, contact [email protected] with the page URL and the specific item you want reviewed.