Employers Request For Premium Supplementation {HC-6}

FORM HC-6 - EMPLOYER'S REQUEST FOR PREMIUM SUPPLEMENTATION. This form is used by small businesses in Hawaii, with fewer than eight eligible employees, to apply for financial assistance in covering the cost of employee health care premiums under the state’s Prepaid Health Care (PHC) Act. This program helps qualifying employers whose required share of health care premiums for single employee coverage exceeds certain thresholds in relation to total wages and business income. The form requires employers to provide detailed payroll and tax records, health care billing statements, and other supporting documents to verify eligibility. It is important to note that supplementation only applies to the employer’s share of premiums, not to employee contributions, dependent coverage, or additional costs from more expensive plans. Once completed, the form allows the Hawaii Department of Labor and Industrial Relations’ Disability Compensation Division to review the employer’s financial situation and determine whether the business qualifies for reimbursement from the special premium supplementation fund, thereby helping small employers continue to provide required health care coverage without undue financial hardship. www.FormsWorkflow.com