RCUH Policies and Procedures

RCUH Open Enrollment FY 2021-2022

FormRelated Policy/Procedure 
1a_RCUH Group Health Enrollment/Change Form (OEB-5Ha)3.520
1b_RCUH Group Health Insurance Waiver Form (OEB-5Wb)3.520
1c_RCUH Declaration of Domestic Partnership3.520
1d_RCUH Affidavit of Dependency for Tax Purposes Form (B-16)3.520
2_RCUH Flexible Spending Enrollment & Change Form (OEB-5F)3.530
3_RCUH Life Insurance Change Form (Form OEB-5L)3.540
4_Supplemental Long-Term Care Insurance: If you wish to enroll in supplemental coverage, please contact (808) 956-3100 or email [email protected] for assistance3.545

Announcements

April 7, 2021 – RCUH HR IMPORTANT – Flexible Spending Account (FSA) Plans: Amendments to Health and Dependent Care FSA Plans 

April 23, 2021 – RCUH HR INFORMATION ONLY – COMING SOON: 2021 RCUH  Benefit Open Enrollment Period is May 3-14, 2021 

May 3, 2021 – RCUH HR IMPORTANT – 2021 RCUH Benefits Open Enrollment Begins – May 3-14, 2021 

Vendor Videos 

Hawaii Medical Service Association (HMSA) Benefits

Hawaii Medical Service Association (HMSA) Well-Being

Kaiser Permanente Benefits

Hawaii Dental Service (HDS) Benefits

National Benefit Services (NBS) Benefits 

1) Health Plans: HMSA, Kaiser & HDS

RCUH Monthly Premium Rate Sheet FY 2021-2022

Policy 3.520 RCUH Health Plans

Policy 3.520A Addendum: RCUH Health Plans

Medical: HMSA

HMSA Plan Differences – HMO vs. PPO

HMSA Plan Comparison PPO

HMSA Plan Comparison HMO

Summary of PPO Benefits:

HMSA Preferred Provider Plan

HMSA Comprehensive Medical Plan

HMSA Comprehensive Medical Plan – Basic

Summary of HMO Benefits:

HMSA Health Plan Hawai’i Plus

HMSA Health Plan Hawai’i Basic

Medical: Kaiser Permanente 

Kaiser Permanente Plan Comparisons

Kaiser Plan A: Summary of Benefits

Kaiser Plan B: Summary of Benefits

Dental: Hawaii Dental Service

HDS: Summary of Benefits

2) Flexible Spending Plan: NBS

RCUH Flexible Spending Account Overview

National Benefits Services Website

Policy 3.530 RCUH Flexible Spending Plan

Policy 3.530A Addendum RCUH Flexible Spending Plan

3) Group Life Insurance: MetLife

RCUH Group Life Insurance Summary of Benefits

Policy 3.540 RCUH Group Life Insurance

4) Supplemental Long-Term Care Insurance: UNUM

For more information/assistance, please contact RCUH Benefits at [email protected] or call 956-3100.