State of Hawaii     

HAWAI`I EMPLOYER-UNION HEALTH BENEFITS TRUST FUND

Forms may be downloaded.  Additional forms will be on-line as they become available.
 

The following are effective July 1, 2008 through June 30, 2009:
 

• EC1 Print and Fill Form       Effective  July, 2007
   

• EC2 Print and Fill Form       Effective  July 10, 2009
   

• PCP Election Change Form (State of Hawaii Employees Only) Link to DHRD Premium Conversion Plan Forms       Effective  July, 2008
   

• Domestic Partner Forms       Updated  July, 2008
   

• Direct Deposit Authorization Form        Effective  July, 2007
   

• Authorized Leave of Absence without Pay          
   

• Authorization for Release of Protected Health Information          
   

• Disability Certification for Dependent Children
   

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