How to Fill Out Hawaii Form HC-15: Why You Need WC-2 Instead

Hawaii Form HC-15 is a Prepaid Health Care reporting form that only authorized PHC plan contractors — the insurance carriers, hospital or medical service associations, and HMOs that provide employer-sponsored health plans in Hawaii — are permitted to complete. If you are an employer, an employee, or a physician, this is not a form you fill out yourself, and it is not posted for public download on the Disability Compensation Division website.¹

Who Actually Completes HC-15

HC-15 is restricted to PHC plan contractors. These are the companies authorized by the state to sell or administer prepaid health care plans under Hawaii’s Prepaid Health Care Act. The Disability Compensation Division (DCD), part of the Department of Labor and Industrial Relations, uses the form to collect compliance information from those contractors.

Individual employers do not complete HC-15. Neither do employees or treating physicians. The DCD’s guidance is direct: if you have questions about the form, contact your PHC plan contractor, because the contractor is the party that handles it.¹

Why You Can’t Download HC-15

Unlike most of the HC-series forms, HC-15 is not published on the DCD’s public forms page. Its data fields and instructions are not documented in any publicly accessible source. The form is distributed only through the plan contractors themselves. A contractor that needs the form or has questions about completing it can reach the DCD’s Prepaid Health Care branch at (808) 586-9151 or comp@hawaii.gov.¹

The Form You Probably Need Instead

Most people who search for HC-15 are actually looking for a different form. The HC series contains several that employers and employees do complete directly, and workers’ compensation uses an entirely separate form for medical reports.

HC-4: Health Care Coverage Questionnaire, used to gather information about an employer’s current coverage.
HC-5: Employee Notification to Employer, filed annually by employees claiming an exemption from mandatory coverage (for example, those already covered under a spouse’s plan).
HC-6: Small Employers Subject to PHC and Employer’s Request for Premium Supplementation.
HC-7: Prepaid Health Care Plan Application.
HC-16: Application for Reimbursement-Type Plan Approval.
HC-17: Application for Service-Type Plan Approval.
HC-61: Application for Self-Insurance Authorization, for employers who want to self-insure rather than buy a contractor’s plan.

These forms are available on the DCD forms page.¹

If You Were Injured at Work, You Want WC-2

HC-15 is often confused with the workers’ compensation physician’s report. That report is Form WC-2, which the treating doctor completes to document a work-related injury, diagnosis, treatment, work restrictions, and return-to-work dates.² WC-2 reports go to the employer or its insurance carrier and to the nearest DCD office; the main Oahu office accepts them at P.O. Box 3769, Honolulu, HI 96812-3769, or by fax at (808) 586-9219. Interim WC-2 reports are filed monthly with the billing invoice and must include a current diagnosis, treatment description, test results, a statement on whether the condition is improving or worsening, and work restriction or return-to-work dates.³

Who to Contact

For HC-15 specifically, start with the PHC plan contractor that issued your health coverage. They are the only entity that completes and submits the form. For general questions about Hawaii’s Prepaid Health Care program, employer obligations, or any of the publicly available HC-series forms, contact the Disability Compensation Division’s Prepaid Health Care branch at (808) 586-9151 or comp@hawaii.gov.⁴

1
Disability Compensation Division. Forms
2
Disability Compensation Division. Frequently Asked Questions
3
Legal Information Institute. Hawaii Code R 12-15-80 – Reports of Providers of Service
4
Disability Compensation Division. Disability Compensation Division Home Page