HSTA VB Active – Enrollment Overview
To enroll, you must complete a EUTF Enrollment Form for Active Employees EC-1H. If you do not enroll eligible members of your family within 30 days (60 days for newborns) of when you or they first become eligible, you must wait until the next Open Enrollment period to do so. The plan year for active employees begins July 1 and ends June 30 of the following year.
After you enroll for the first time, you will receive identification cards from the plans as follows:
- HMSA and HDS will issue two identical ID cards showing the name of the subscriber
- Kaiser and CVS Caremark issue an ID card for each enrolled member of a family upon initial enrollment
- ChiroPlan Hawaii under Royal State National, USAble and VSP –ID cards are not required to obtain services.
Dual Enrollment Is Not Allowed
No person may be enrolled in any EUTF benefit plan as both an employee-beneficiary and dependent-beneficiary, nor may children be enrolled by more than one employee-beneficiary (dual enrollment). In addition, if you and your spouse, domestic partner or civil union partners are both employee-beneficiaries, the employer contribution cannot exceed a family plan contribution in accordance with Chapter 87A-32(3), Hawaii Revised Statutes (HRS). However, both employee-beneficiaries are able to select EUTF Self-only plans.
Medicare Part B Premium Reimbursement
If you and your dependent are enrolled in a EUTF active employee medical plan, you and your dependent are not eligible for Medicare Part B reimbursement. However, if you are an active employee, enrolled in Medicare Part B and covered by the EUTF retiree medical plan as a dependent through your spouse/DP/CUP, your spouse/DP/CUP is entitled to Medicare Part B reimbursement on your behalf.
Change of Coverage –Special Enrollment Period due to a Qualifying Event
You are eligible to change coverage outside of the Open Enrollment period for the following reasons:
- You marry and want to enroll your spouse and/or newly eligible dependent children. A copy of your marriage certificate is required.
- You need to enroll a newborn or newly adopted child. In order to add a newly adopted child to your coverage, you must provide appropriate documents verifying the adoption in order to have the application accepted. To enroll a newborn you do not need to attach a copy of the birth certificate or submit the social security number. A copy of the birth certificate is required only if the child has a different last name from the employee. A social security number is required within
60 days of the date of birth.
- You have a change in family status involving the loss of eligibility of a family member (e.g., legal separation, divorce, death, child turns age 26). See common qualifying events that allow enrollment changes for active employees for a list of the required documents.
- Your spouse’s or eligible dependent’s employment status changes resulting in a loss of health coverage. A copy of the Loss of Coverage letter from your previous employer or insurance plan is required.
- You move out of your plan’s service area.
To change your coverage, you must complete Form EC-1H and submit it through your employer representative within 30 days of the date of the event. Generally, deletion of dependents is effective on a prospective basis, depending upon receipt of the enrollment form by the EUTF. Dependent children are automatically terminated from the medical and prescription drug plans at the end of the month that they attain age 26 and do not require the completion of an enrollment form to delete coverage. For dental and vision, coverage for the dependent terminates at the age of 24 if the dependent is a full time student or 19 if not, or after an application has been submitted to delete coverage for the dependent. If events are filed within 30 days of the qualifying event date, some events allow for a selection of the Coverage and Premium Contribution Start Dates. These events include: Adoption, Birth (filed within 60 days of the date of birth), Guardianship, New Eligible Student, Marriage, New Domestic Partner, New Civil Union Partner, Reinstatement in Employment, and Return from Authorized Leave of Absence (if not currently enrolled). See common qualifying events that allow enrollment changes for active employees.
End of Coverage
Common situations resulting in loss of coverage for you and your dependents are:
- You do not make required premium payments.
- You die, subject to exceptions.
- You fail to comply with the EUTF Administrative Rules.
- You file fraudulent claims.
- Your dependent reaches the limiting age.
- Your surviving spouse, domestic or civil union partner remarries or enters into another partnership.
Effective Dates of Coverage for New Hires and Employees Newly Eligible for EUTF Benefits
You have a choice of when you would like your coverage to begin. You may choose either your date of hire or date you became newly eligible for EUTF benefits, or the first day of the first pay period from your date of hire or date you became newly eligible for EUTF benefits, or the first day of the second pay period from your date of hire or date you became newly eligible for EUTF benefits. This rule also applies to some qualifying changes made during the plan year.
Although your coverage begins on the date you select, your enrollment may not be processed right away. Therefore, if you need to fill a prescription or go to the doctor prior to receiving your ID cards you should email EUTF at firstname.lastname@example.org. In the email subject line type “URGENT –Confirmation of coverage needed”. EUTF checks this email daily and will contact the carrier to rush your enrollment after it receives the EC-1H from your employer.
If you were enrolled in the EUTF with your previous public employer and your coverage is still in effect on the day you begin work with your current employer (COBRA coverage excluded), your coverage is continuous and you will experience no break in coverage (see transfer of employment below).
Transfer of Employment
If you terminate employment and are rehired by the same public employer within the same pay period or the next consecutive pay period, you are considered as having transferred employment and you shall be treated as if continuously enrolled in the EUTF benefit plans. If you terminate employment and are rehired by a different public employer (e.g., state to county or county to county) within the same pay period or the next consecutive pay period, you are allowed to change between plans, including adding or deleting dependents and changing coverage tiers. For purposes of this section only, the different public employers are: 1) State, including executive, legislative and judicial branches, Department of Education, University of Hawaii, Hawaii Health Systems Corporation, Office of Hawaiian Affairs, and all Charter Schools; 2) City and County of Honolulu; 3) County of Hawaii; 4) County of Kauai, and 5) County of Maui.
Effective Date of Termination
In general, when an event causes you or your dependent’s coverage to terminate, such termination will be effective on the first day of the first pay period following the occurrence of the event, e.g., divorce, end of domestic or civil union partnership, death, surviving spouse/partner remarries, or child ceases to be eligible for coverage. There may be certain instances in which the effective date of termination is different, e.g. on the last day of the month in which a dependent reaches the limiting age. You may obtain additional information by referring to the EUTF administrative rules.
Rejection of Enrollment
Enrollment in EUTF benefit plans is contingent on meeting all eligibility criteria detailed in the EUTF administrative rules. Any enrollment application may be rejected if it is incomplete or does not contain all information required.
An enrollment application shall be rejected if:
- The application seeks to enroll a person who is not eligible to enroll in the benefit plan for which enrollment is requested;
- The application is not filed within the time limitations prescribed by the rules (see common qualifying events that allow enrollment changes during the plan year for active employees.)
- The application contains an intentional misstatement or misrepresentation of a material fact or contains other information of a fraudulent nature;
- The employee-beneficiary owes past due contributions or other amounts to the EUTF; or
- Acceptance of the application would violate applicable federal or state law or any other provision of the rules.
Employee-beneficiaries will be notified by mail of the rejection of any enrollment application