HAR §12-12-63. Other employer reports

(a) Status report. Every employer for whom services are performed in employment shall file a report on a form prescribed by the director to determine liability for coverage within ten days after the status report form is mailed by the department. This report shall provide information such as: name of health care contractor, plan number, group number, effective date of plan, number of employees who claim exemption and reason thereof, and employer-employee premium cost for individual and dependents coverage. The employer's health care plan shall accompany this report, if the plan has not been approved by the director. (b) Employer shall give the department thirty days written notice prior to change in health care plan or health care contractor. (c) Employee notification to employer. (1) Any employer whose employee claims exemption from the statute shall, upon request by the director, file a statement with the director, signed by the employee on a form provided by the department. The form shall be filed with the employer within ten days of employment or change in status and retained in employer’s files for a minimum of two years. (2) On December 31 of each year, each employee who signed an exemption form shall sign a statement re-affirming the employee’s claim for exemption on a form prescribed by the department. The employer shall retain such forms for a minimum of two years and shall file the exemption forms with the director upon request. [ Eff: 5/7/81; am 2/28/11] (Auth: HRS §393-32) (Imp: HRS §§393-17, 393-21)