The federal government requires employers to provide health insurance for some employees, but Hawaii’s laws go even further. Under the Hawaii Prepaid Health Care Act, employees who work at least 20 hours per week for four consecutive weeks are eligible for health insurance coverage by their employer.

However, a few groups are excluded from that requirement. This includes insurance and real estate salespeople paid on commission, seasonal agricultural workers, and people working for family members. Once employees become eligible for coverage, benefits kick in on the first day of the following month.

If an employee chooses  to opt-out of their employer’s health insurance (e.g. if their insurance is already being covered by a spouse), they need to fill out an HC-5 form every year and provide valid proof of health care coverage.

At this time, the 2024 HC-5 Form is not yet available. We will update this FAQ when it is released by the State Department of Labor.

Refer to the Health Care Fees page of your packet to view a list of the health care plans available to your employees.  

It’s OK if your employee wants to opt-out of their health care benefits (e.g. if their insurance is already being covered by a spouse). 

However, they need to complete and submit a new HC-5 form every year that they choose to opt-out, along with valid proof of health care coverage. We will include a copy of the HC-5 form in your employees' open enrollment instruction letters to make it easy for them to complete should they select to opt-out.

At this time, the 2024 HC-5 Form is not yet available. We will update this FAQ when it is released from the State Department of Labor.

Employees can sign up for, or make a change to their health insurance benefits after they complete the initial eligibility period, or during their employer’s annual open enrollment period.

Outside of those eligibility windows, they can change or sign up for a plan within 30 days of a significant life event, like marriage, divorce, the birth or adoption of a child, the death of a covered family member, or a change in a spouse’s work status that affects benefits coverage.

One of employees’ biggest concerns is how much their health insurance is going to cost. In general, employees share the cost of health care services with their employer and the plan they select. But it’s not always a simple equation. There are several different costs that go into the total expense of health care. Let’s break them down:

• Monthly Premium. This is the monthly fee for your health insurance plan. In Hawaii, the employer must pay at least half of the premium, as long as the employee’s share of the cost is no more than 1.5% of their wages.
• Deductible. This is the amount you must pay out-of-pocket before your insurance plan kicks in and starts to cover the cost of your medical services.
• Copay. A copay, or copayment, is the predetermined fee you have to pay for certain services or medical visits. Copays do not count toward your deductible, but they do count toward your out-of-pocket maximum.
• Out-of-Pocket Maximum. The out-of-pocket maximum is a cap on the total amount you will have to pay on medical bills in a calendar year. Once you reach the cap, your insurance provider will cover 100% of your medical costs from then on.
• Coinsurance. This is the insurance company’s share of your medical bill (after your deductible has been met). If your plan provides for 80% coinsurance, that means your insurance provider will pay for 80% of the cost, and you’ll be responsible for the remaining 20%.
• Care not covered by insurance. Also referred to as “exclusions” by health care carriers. If a test, procedure or medication is not covered by your insurance plan, you may need to pay for it yourself.

Here is a list of terms you may come across during Open Enrollment:

• 1.5% Option: In accordance with the Hawaii Prepaid Health Care Act, employers may require employees to pay 1.5% of the employee's gross monthly wages, not to exceed 50% of the Health Care Fees for single coverage of the base health plan.
• Additional Health Plan Offerings: If your Base Health Plan is an HMSA plan, you may choose to offer Kaiser as well, or vice versa. Employees will be responsible for any additional costs for these options.
• AM: AM stands for Acupuncture and Massage.
• Base Coverage: Base Coverage is the coverage level selected as part of the Employer Paid Base Health Care Offering for a particular benefit group. You can select the Single option or Other (e.g., Employee + Child(ren), Employee + Spouse, or Family).
• Base Health Plan: The Base Health Plan is the health plan selected as part of the Employer Paid Base Health Care Offering for a particular benefit group.
• Base Riders: Base Riders are the rider(s) selected as part of the Employer Paid Base Health Care Offering for a particular benefit group. In addition to medical only, you can choose to add drug, vision, and dental coverage to your base health plan.
• Benefit Group: A Benefit Group is used to distinguish different health plan offerings for different employee groups within a company (for example, Primary Staff vs. Managers). State and federal laws dictate how employers can designate these benefit groups.
• Client Authorized Health Plan Selection Signature: The Health Care Offering Selection Form must be signed and submitted by an individual authorized to make health plan decisions on behalf of your company.
• Comparable Health Care Offering: ProService strives to provide you and your employees with the best health plan options available, which means changes in our overall offering year to year. By selecting the Comparable Health Care Offering(s) you are opting for the available plans and benefit group structure that most closely resembles what you currently offer your employees.
• Employer Paid Base Health Care Offering: As mandated by Hawaii’s Prepaid Health Care Act, employers must pay for a medical plan (at minimum) for eligible employees. Employers can choose to cover additional riders, such as drug and dental, or additional coverage, such as family coverage. The Employer Paid Base Health Care Offering defines what type of health plan, riders, and coverage level you are choosing to provide for a particular benefit group.

That depends on your carrier.

• If you are an HMSA member, you will receive a new medical insurance card in January.
• If you are a Kaiser or HDS member, you will not receive a new insurance card.

If you're not changing your health plans, your subscriber number will remain the same and you can use your current cards until the new ones arrive.

For more information, download this helpful FAQ sheet on Medical Insurance Cards. 

Yes. Your health care coverage for the coming year is effective January 1, even if you don't receive your new cards by then.

For more information, download this helpful FAQ sheet on Medical Insurance Cards. 

There are 3 ways to get a copy of your insurance card:

1. Online Self-Service. Register for an account on your carrier's website (see links below) and download your insurance card from the web.

• • For HMSA: Go to hmsa.com and click on Member Login to get started.
  • For Kaiser: Go to kp.org/registernow and create your account.
  • For HDS: Go to hawaiidentalservice.com/hds/registration to register.

2. Contact the ProService Employee Service Center at 808-394-4162 for assistance. Please allow 7-10 days to receive your new cards after reordering.

3. Contact your carrier directly:

• • HMSA Customer Service: (808) 948-6079
  • Kaiser Hawaii Customer Service: 1-800-966-5955
  • HDS Customer Service: 1-844-379-4325

For more information, download this helpful FAQ sheet on Medical Insurance Cards.