HSTA VB – FAQs

HSTA VB Active

I’m going to be getting health benefits from another non – EUTF plan under my spouse’s plan. What do I need to do?

You need to complete an EC-1H and give it to your personnel office within 30 days of the date of your coverage under your spouse’s plan. If your coverage under your spouse’s plan starts on the first of the month, your EUTF coverage ends the day before.

I’m giving birth soon (or my wife is giving birth soon). How do I add my newborn?

You need to complete an EC-1/EC-1H and give it to your Personnel Office within 180 days of the baby’s birth date. You choose the effective date: 1) date of birth, 2) First day of the pay period following the birth, or 3) First day of the Second pay period following the birth. You will need to submit the child’s birth certificate only if the child has a different last name from the employee and the child’s Social Security Number within 180 days of the date of birth.

I’m getting married and want to add my spouse. What do I need to do?

You need to complete an EC-1H and turn it into your personnel office within 30 days of your marriage. Attach a copy of your marriage certificate or if it’s not available within 30 days, send it to EUTF within 60 days of your marriage. You can add your spouse to your current plans – you cannot change plans. The effective date of your new spouse’s coverage is the date your personnel office receives your EC-1H. If notification is submitted prior to your marriage, the effective date is the date of marriage.

I’m getting divorced and I’m covered under my spouse’s non-EUTF plans. What should I do?

You should complete an EC-1H and turn it into your personnel office within 30 days of your loss of coverage under your spouse’s plan. You need to attach a loss of coverage letter from your former spouse’s employer or the health benefits carrier detailing the type of coverage lost, the date of loss, and the names of who lost coverage. Your effective date of coverage under EUTF plans is the day following your loss of coverage under your former spouse’s plan.

I’m getting divorced and my spouse is covered under my EUTF plans. What should I do?

You should complete an EC-1H and turn it into your personnel office within 30 days of the date of divorce to terminate your spouse’s coverage. Attach pages 1 and 2 of the divorce decree along with the signature page and any page that includes health settlements for the children. Your former spouse’s coverage ends the last day of the pay period in which the divorce date occurs. If it takes longer than 30 days to get a copy of the divorce decree, turn in the EC-1H to your personnel office without it and give EUTF a copy as soon as it’s available. Your ex-spouse will be mailed a COBRA continuation packet.

My spouse lost his/her job and he/she and I were covered under his/her non-EUTF plan (Loss of Coverage). Can I get EUTF coverage right away?

Yes. You need to complete an EC-1H and turn it into your personnel office within 30 days from the date you lose coverage under your spouse’s plan. You need to attach a loss of coverage letter from your spouse’s employer or the carrier detailing the type of coverage lost, the date of loss, and the names of who lost coverage. Your effective date of coverage under EUTF plans is the day following your loss of coverage under your spouse’s plan.

What are my options for insurance coverage when I am on leave without pay?

If your leave without pay (LWOP) is expected to last longer than 30 days you have two options to choose from:

  1. Voluntarily cancel your health benefit plan enrollments due to leave without pay.
    1. You will need to complete an EC-1 Enrollment Form within 30 days of the beginning of the LWOP to cancel all your plans. The effective date of the cancellation shall be the end of the pay period during which the leave of absence without pay begins.
    2. You may re-enroll in the same benefit plans upon return from LWOP by completing an EC-1 Enrollment Form and submitting to your employer. The form must be submitted within 30 days of returning from the LWOP.
  2. Continue all your plans during LWOP by paying the premiums due by the end of the month
    1. Your premiums are determined by your bargaining unit and plan type.
    2. Send payments to: EUTF, PO Box 30700, Honolulu, HI 96820
How are my benefits coordinated with other insurance that I have?

Coordination of benefits refers to the process of applying benefits from two insurance plans to a claim for services. For example, when an HMSA member is covered by two HMSA plans (dual membership), or by one HMSA plan and a plan from another carrier (dual coverage), benefits are usually coordinated so that all possible payments are made on claims for services the member received.

In dual membership and dual coverage situations, the carriers work together to establish which plan pays first. The plan that pays first is called the primary plan. Once primacy is determined, the other plan pays second, or is the secondary plan. After benefits from the primary plan have been applied, the secondary plan will often coordinate to pay additional benefits toward the claim.

To ensure that you receive the benefits of your dual coverage, you must present your insurance cards at the time of service to the provider, including the pharmacy.

Certain conditions must exist for two insurance plans to coordinate.  The two plans must be similar in order for them to be able to coordinate.  For example, a dental plan can’t be coordinated with a medical plan.

What is Premium Conversion Plan?

Premium Conversion Plan (PCP) is a voluntary benefit plan, administered by the Department of Human Resources Development (DHRD) that allows State employees to pay their health benefit plan premiums on a pretax basis and is being offered pursuant to Section 125 of the Internal Revenue Code. For more information, go to the DHRD website at dhrd.hawaii.gov. County employees should contact their personnel office for information on their section 125 plan.

What and when is Open Enrollment?

Open Enrollment is your only opportunity to make changes to your coverage without a qualifying event.  During Open Enrollment you can:

  • Add a plan, change from one plan to another, or drop a plan
  • Add a dependent or drop a dependent
  • Change coverage tiers such as changing from single to family or family to 2-party

You will be notified by your personnel office when the next open enrollment period will be.  Open Enrollment ran from April 1 – April 30, 2015 for plan changes taking effect on July 1, 2015.

When can I add my spouse or dependent child?

There are situations in which you may experience a qualifying event which would allow you to make plan changes during the plan year. Please see the list of common qualifying events. If you have not experienced a qualifying event, you will have to wait until the next Open Enrollment period.

I just had a child, what do I need to enroll my newborn?

In order to enroll your newborn you will need to submit an EC-1 Enrollment Form within 180 days from the date of birth. A copy of the child’s birth certificate (if the child has a different last name from the employee), and the child’s social security number within 60 days of the date of birth.

My dependent is no longer eligible (i.e., divorce, legal separation or dissolution of domestic partnership, etc.). Do I need to notify the EUTF?

Divorced or legally separated spouse/civil union partners, or domestic partners whose partnership has been dissolved are no longer eligible for EUTF plans, regardless of whether your divorce decree indicates that coverage must be afforded to your spouse.  You must notify the EUTF within 30 days from the divorce or legally separated filing dates or date of the termination of domestic partnership and terminate your dependent’s coverage.

Please submit an EC-1/EC-1H form to your DPO to remove your dependent from your EUTF plans.  Your dependent will be terminated the first day of the first pay period following their loss of eligibility.  Claims incurred during the period of ineligibility which occurred prior to you notifying the EUTF of their change in eligibility will be the responsibility of the member and you may have to reimburse the insurance carrier(s) for claims paid.

My child is no longer eligible (i.e., graduated from college, got married, etc.) but is under age 24. Do I need to notify the EUTF?

You must notify the EUTF and terminate your child’s dental and vision coverage within 30 days from when they become ineligible, regardless if they are under age 24.  This does not apply to medical and prescription drug coverage, which they may remain enrolled in to age 26).

Please submit an EC-1/EC-1H form to your DPO to remove your child from your dental and vision plans.  Your child will be terminated the first day of the first pay period following their loss of eligibility.  Claims incurred during the period of ineligibility will be the responsibility of the member and you may have to reimburse the insurance carrier(s) for claims paid.

My child is turning 19 soon. What do I need to do to continue their coverage?

In order to have your child’s dental and vision coverage continued through age 23 you must provide the EUTF with a student verification letter from an accredited school, college or university, on the school’s letterhead with the registrar’s signature confirming full time status, within 60 days after becoming a full time student.  Transcripts are not acceptable.

Who is eligible for active health benefits?

Active employees include those who are employed by the State or County who will be working for more than three months in a position that requires more than 50% full-time equivalent.  As an active employee you are eligible to enroll:

  • Yourself
  • Your spouse, domestic partner, or civil union partner
  • Your children under age 26 for medical and prescription drug coverage.  This includes children by birth, marriage (stepchild), or adoption or placement for adoption.  For dental and vision coverage, dependent children under the age 19, and from age 19 through age 23 if they are unmarried and full time students, are covered.  For children covered under legal guardianship, their coverage will terminate at 18.
  • Your child, regardless of age, who are incapable of self-support because of a mental or physical impairment that existed prior to the child reaching age 19.

Part-time and temporary employees also have plans that are available to them.  Employees not eligible for the EUTF health plans should contact their personnel office for more information.

What is the difference between HSTA VB plans and EUTF plans?

There are differences in premium contribution amounts and, in certain instances, in plan benefits.  Please consult the employee reference guide to determine what the premium amounts will be and any differences in benefits.

Who can enroll in HSTA VB plans?

You must currently be enrolled in any HSTA VB plan, including life insurance, to enroll in the HSTA VB plans.  If you are not currently enrolled in a HSTA VB plan you may only enroll in EUTF plans.  Employees enrolled in HSTA VB plans who change to the EUTF plans may NOT change back to HSTA VB plans in the future.  Additionally, employees enrolled in the HSTA VB plans may not enroll in some HSTA VB plans and some EUTF plans – they must be enrolled in all HSTA VB plans or all EUTF plans.