RCUH Policies and Procedures

RCUH Monthly Premium Rate Sheets

Related Information
RCUH Monthly Premium Rate Sheet — Active Employees
RCUH Monthly Premium Rate Sheet — COBRA

Guide to Benefits & Benefits At a Glance

Related Information
Benefits At A Glance
Benefits Summary by FTE (Regular and Non-Recruited)
Benefits Summary by FTE (Reg, Relief, Non-Recruited) - TBA
Guide to Benefits - Regular Status Employees
New Hire: Benefits Information Important Dates to Know One-Pager
New Hires FAQ
Active Employees FAQ

Health Insurance

ACTIVE EMPLOYEES FORMS/RELATED INFORMATION
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

Flexible Spending Accounts

Forms/Related Information
FSA Plan Document
RCUH NBS Transportation Fringe Benefit Plan Document
RCUH Flexible Spending Accounts & PreTax Transporation Benefits Plan Enrollment/Change Form (Form B-5F)
RCUH Flexible Benefits - Plan Highlights
What is a Flexible Spending Account Brochure
Healthcare Expense Account Sample Expenses
What is a Dependent Care Assistance Program (DCAP)
NBS Web Portal First Time Login Instructions
NBS Mobile App Instructions

Time-Off & Special Leaves

Forms & Related Information
RCUH eTimesheet Leaves Guide
Vacation Forfeiture Calculator
FAMILY & MEDICAL LEAVE FORMS/RELATED INFORMATION (Policy 3.660)
RCUH Family & Medical Leave Request Form (B-11)
FMLA & HFLL Rights & Responsibilities
WH-380-E Own Serious Health Condition
WH-380-F Care for Family Member with Serious Health Condition
WH-384 Military FMLA Qualifying Exigency
WH-385 Military FMLA Care for Covered Service Member
HFLL-1 Form Care for Family Member with Serious Health Condition (HFLL Only)
Family & Medical Leave Guide for Employees - LINK PENDING
Family & Medical Leave Guide for PIs and Supervisors - LINK PENDING
Family & Medical Leave Definitions
Family & Medical Leave FAQ
OTHER LEAVE FORMS/RELATED INFORMATION
RCUH Advanced Sick Leave/Temporary Disability Insurance Request Form - Contact RCUH Employee Benefits Section ([email protected])
RCUH Leave for Parent-Teacher Conference Request Form (B-1)
RCUH Leave of Absence: Victims Protection Leave Form (B-21)

Financial Wellness & Well-being Support

Forms/Related Information
MetLife Monthly Webinar Information - LINK PENDING
Supplemental Retirement Annuity (SRA) Agreement for Salary Reduction Form (B-6)
Life Insurance: Summary of Benefits
Life Insurance: Certificate of Insurance
Long Term Disability: Summary of Benefits - Employees under $8K
Long Term Disability: Summary of Benefits - Employees $8K and Over
Long Term Disability: Certificate of Insurance - Employees under $8K
Long Term Disability: Certificate of Insurance - Employees $8K and Over
Long Term Care: Full Plan Document
Long Term Care: Rates for Enrollments Prior to July 2022
Long Term Care: Rates for Enrollments July 2022 or Later
Employee Assistance Program (MetLife) Flyer
RCUH ID Application Form (E-18)

Career Development

Forms/Related Information
RCUH Tuition Reimbursement Program Information (One-Pager)
RCUH Tuition Reimbursement Program Application Authorization Form
RCUH Tuition Reimbursement FAQ

Disclosure & Coverage Notices

Related Information
RCUH Creditable Coverage - Drug and Medicare Disclosure Notice
Consolidated Omnibus Budget Reconciliation Act (COBRA) - LINK PENDING
Important Information about your COBRA Continuation Coverage Rights
Premium Assistance Under Medicaid and the Children's Health Insurance Program (CHIP)
Women's Health and Cancer Rights Act of 1998 - LINK PENDING
Newborns' and Mothers' Health Protection Act - LINK PENDING
No Surprises Act - LINK PENDING