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State of Hawaii

Hawaii Employer-Union Health Benefits Trust Fund

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    • EUTF Active Forms
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Active Employees Resource > EUTF Active Forms

EUTF Active Forms

  •  EC-1 Active Print and Fill Form “Effective July 1, 2013″ (PDF)   04/22/13
  •  EC-1 Active Print and Fill Form “Effective January 1, 2012″  (PDF)   12/11/12
  •  Authorized Leave of Absence without Pay  (PDF)   07/27/12
  •  PCP Election Change Form (State of Hawaii Employees Only) – Link to DHRD Premium Conversion Plan Forms  (PDF)   Effective 07/01/08
  •  Authorization for Release of Protected Health Information Print and Fill Form  (PDF)
  •  Disability Certification for Dependent Children  (PDF)
  •  Civil Union Forms   09/14/12
  •  Domestic Partner Forms

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