RCUH Policies and Procedures

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Form	Related Policy/Procedure
RCUH Monthly Premium Rate Sheet — Active Employees	3.520, 3.520A
RCUH Monthly Premium Rate Sheet — COBRA	3.285, 3.520, 3.520A
Benefits at a Glance
Benefits Summary by FTE (Regular and Non-Recruited)
Guide to Benefits - Regular Status Employees
New Hire: Benefits Information Important Dates to Know One-Pager
New Hires FAQs
Active Employees FAQ
RCUH Medical Plan Comparison - Active Employees
RCUH Open Enrollment All-in-One Form (OE-B5)
Group Health Insurance Enrollment/Change Form: Regular-Status Employees (B-5H)
Group Health Insurance Waiver Form: Regular-Status Employees (B-5Wb)
Group Health ACA Insurance Enrollment/Change/Waive Form: Non-Recruited Employees (B-5A)
RCUH New Hire Worksheet
MEDICAL PROVIDER INFORMATION - HAWAII MEDICAL SERVICE ASSOCIATION (HMSA)
HMSA Benefits Summary All Plans
HMSA CompMed Basic - Summary of Benefits & Coverages
HMSA CompMed - Summary of Benefits & Coverages
HMSA PPO - Summary of Benefits & Coverages
HMSA HMO - Summary of Benefits & Coverages
HMSA CompMed Basic - Guide to Benefits
HMSA CompMed - Guide to Benefits
HMSA PPO - Guide to Benefits
HMSA HMO - Guide to Benefits
HMSA PPO Plan Type - Drug Rider
HMSA HMO Plan Type - Drug Rider
HMSA Active & Fit Direct Program
HMSA Complementary Care - 24-25
MEDICAL PROVIDER INFORMATION: KAISER PERMANENTE HAWAII
Kaiser RCUH Benefit Highlights
Kaiser Standard (Plan A) Summary of Benefits
Kaiser Standard (Plan A) Guide to Health Plan
Kaiser Standard (Plan A) Benefit and Payment Chart
Kaiser Comprehensive (Plan B) Summary of Benefits
Kaiser Comprehensive (Plan B) Guide to Health Plan
Kaiser Comprehensive (Plan B) Benefit and Payment Chart
Kaiser CAM+N Flyer
5 Great Reasons to Choose Kaiser Permanente
Getting Started with Kaiser Permanente
Kaiser Away from Home Care Options
Kaiser Fit Rewards & FAQ
Kaiser Mail-Order Pharmacy
Kaiser Mental Health & Wellness
Kaiser Online Tools Brochure
Kaiser Optical 150
Kaiser Out of Area Dependent Coverage
DENTAL PROVIDER INFORMATION - HAWAII DENTAL SERVICE (HDS)
HDS Benefits Summary
HDS Information Packet
HDS SmileWell Overview
DISCLOSURES & COVERAGE NOTICES
Creditable Coverage Disclosure Notice
2024 Personnel Action & Payroll Calendar
2024 Personnel Action & Payroll Schedule
2025 Personnel Action & Payroll Calendar
2025 Personnel Action & Payroll Schedule
State and Federal Employment Law Poster (2023)
EEO Complaint Form (O-3)	3.110, 3.120
Equal Employment Opportunity Policy Statement	3.110
RCUH Withdrawal of Complaint and Release Form (O-4)	3.110, 3.120
Attestation of Exception to EIC Review (No RCUH HR Review needed) - Form ICQ-01	3.225
Independent Contractor Questionnaire (ICQ): Request for RCUH HR Review - Form ICQ-02	3.225
Independent Contractor Memo Template	3.225
Independent Contractor Memo - Instructions	3.225
Guest Speaker Memo Template	3.225
Guest Speaker Memo - Instructions	3.225
Master EIC Determination - Non-Employee Research Study Participant	3.225
Master EIC Determination - Non-Employee Non-Compensated Project Support	3.225
Master EIC Determination - Non-Employee Special Duty Police	3.225
Employees - Completing an eTimesheet (Standard)
Principal Investigators - Approving eTimesheets (Standard)
Employees - Completing an eTimesheet (Task Order)
Principal Investigators - Approving eTimesheets (Task Order)
Acknowledgement - Receipt of Company Property Financial Obligation Form (O-6)
Ethics Checklist	3.210
Ethics Guide	3.210
Form I-9 with RCUH Address
New Hire Reference Guide (for Non-Recruited Hires)	3.005
New Hire Reference Guide (for Regular Hires)	3.005
Personnel Action Form	3.342, 3.350, 3.360, 3.620, 3.674
Student Assistant Pay Schedule	3.211
HR Portal Access Form — Existing DC	3.710
HR Portal Access Form — New DC	3.710
How to Fill Out an HR Portal Access Form: Existing DC	3.710
How to Fill Out an HR Portal Access Form: New DC	3.710
RCUH User Acknowledgement	3.710
Part A - HR Portal User Guide - Overview	3.710, 3.810
Part B - HR Portal User Guide - Recruitment & Employment I
Part C - HR Portal User Guide - Recruitment & Employment II
Part D - HR Portal User Guide - Payroll
Part E - HR Portal User Guide - HR Information Systems I
Part F - HR Portal User Guide - HR Information Systems II	4.400
Confidentiality Requirements for Personal Identifiable Information Acknowledgement Form	3.480
Memo - Unforeseen Disruption in Work Schedules	3.262
Model RCUH Safety Program	3.930
Supervisors Report of Industrial Injury Form	3.930
RCUH 12-Month/Needs Based Performance Evaluation Short Form (Excel Format)	3.410
RCUH 12-Month/Needs Based Performance Evaluation Long Form (Excel Format)	3.410
Attachment B User Guide	3.234
Common External Publications	3.234
Manual PRF - Change Account Number	3.234
Manual PRF - Ads	3.234
RCUH Recruitment Procedure	3.234
Employment of Relatives & Other Close Relationships Form	3.255, 3.262
Interview Comment Sheet	3.235
Job Description Template	3.234
Position Requisition Form	3.234
RCUH Certification of Compliance - Prospective New Hire
Telephone Reference Check Form	3.235
HMSA Akamai Advantage Form	3.550
HMSA Automatic Payment Application	3.550
HMSA Authorized Contact Form	3.550
HMSA Akamai Advantage Summary of Benefits	3.550
Kaiser Senior Advantage Form	3.550
Kaiser Automatic Payment Application	3.550
Kaiser Senior Advantage Summary of Benefits	3.550
MetLife Life Insurance Policy (RCUH Retirees)	3.550
Termination of Employment Form	3.285
Termination General Information (Regular, Non-Regular, Relief status employees)	3.285
Termination General Information (Non-Recruited Employees)	3.285
COBRA Monthly Rate Sheet (Medical and Dental premiums): Effective 07/01/2021 - 06/30/2022	3.285
COBRA Notification - For reference only (actual notification to be sent upon processing of termination action)	3.285
HDS (Dental) COBRA Enrollment Form	3.285
Kaiser (Medical) COBRA Enrollment Form	3.285
UNUM (Long Term Care) Continuation of Coverage Application	3.285
MetLife (Life Insurance) Portability Application	3.285
MetLife (Life Insurance) Conversion Application	3.285
NBS (Flexible Spending Healthcare) Continuation of Coverage Application	3.285
TIAA (Retirement Account) Options When Terminating with RCUH	3.285
RCUH Mahalo Survey	3.285
Employee Time/Leave Certification Form	3.340, 3.342, 3.344, 3.620, 3.640, 3.650, 3.670, 3.672, 3.674, 3.676, 3.678
RCUH Request for Timesheet Correction Form	3.810
H-1B Request Form	3.212
J-1 Change Form	3.212
J-1 Completion Form	3.212
J-1 Request Form	3.212
J-2 Information Form	3.212
RCUH Pre-Arrival and Orientation Information for J-1 Exchange Visitors	3.212
TN Request Form	3.212
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Research Corporation of the University of Hawaiʻi

Research Corporation of the University of Hawaiʻi

Research Corporation of the University of Hawaiʻi

RCUH Policies and Procedures

3.000 Human Resources Document Library