COBRA – FAQs

If I did not make the premium payment on time and my coverage was canceled what can I do?

You may want to contact your plan and ask if they will reinstate your coverage; however, if your coverage was terminated for not making the payment within the grace period, the plan is not required to reinstate your coverage.

Who pays for COBRA coverage?

Your group health plan can require you to pay for COBRA continuation coverage. The amount charged to qualified beneficiaries cannot exceed 102% of the cost to the plan for similarly situated individuals covered under the plan who have not incurred a qualifying event. In determining COBRA premiums, the plan can include the costs paid by employees and the employer, plus an additional 2% for administrative costs.

For qualified beneficiaries receiving the 11-month disability extension, the COBRA premium for those additional months may be increased to 150% of the plan’s total cost of coverage for similarly situated individuals.

COBRA charges to qualified beneficiaries may be increased if the cost to the plan increases but generally must be fixed in advance of each 12-month premium cycle. The plan must allow you to pay the required premiums on a monthly basis if you ask to do so, and the plan may allow you to make payments at other intervals (for example, weekly or quarterly). The election notice should contain all of the information you need to understand the COBRA premiums you will have to pay, when they are due, and the consequences of late payment or nonpayment.

When you elect continuation coverage, you cannot be required to send any payment with your election form. You can be required, however, to make an initial premium payment within 45 days after the date of your COBRA election (that is the date you mail in your election form, if you use first-class mail). Failure to make any payment within that period of time could cause you to lose all COBRA rights. The plan can set premium due dates for successive periods of coverage (after your initial payment), but it must give you the option to make monthly payments, and it must give you a 30-day grace period for payment of any premium.

You should be aware that if you do not pay a premium by the first day of a period of coverage, but pay the premium within the grace period for that period of coverage, the plan has the option to cancel your coverage until payment is received and then reinstate the coverage retroactively back to the beginning of the period of coverage. Failure to make payment in full before the end of a grace period could cause you to lose all COBRA rights.

If the amount of a payment made to the plan is incorrect but is not significantly less than the amount due, the plan is required to notify you of the deficiency and grant a reasonable period (for this purpose, 30 days is considered reasonable) to pay the difference. The plan is not obligated to send monthly premium notices.

Some employers may subsidize or pay the entire cost of health coverage, including COBRA coverage, for terminating employees and their families as part of a severance agreement. If you are receiving this type of severance benefit, talk to your plan administrator about how this impacts your COBRA coverage or your special enrollment rights.

Is a divorced spouse entitled to COBRA coverage from their former spouses’ group health plan?

Under COBRA, participants, covered spouses and dependent children may continue their plan coverage for a limited time when they would otherwise lose coverage due to a particular event, such as divorce (or legal separation). A covered employee’s spouse who would lose coverage due to a divorce may elect continuation coverage under the plan for a maximum of 36 months. A qualified beneficiary must notify the plan administrator of a qualifying event within 60 days after divorce or legal separation. After being notified of a divorce, the plan administrator must give notice, generally within 14 days, to the qualified beneficiary of the right to elect COBRA continuation coverage.

Can I extend my COBRA continuation coverage?

If you are entitled to an 18 month maximum period of continuation coverage, you may become eligible for an extension of the maximum time period in two circumstances. The first is when a qualified beneficiary is disabled; the second is when a second qualifying event occurs.

Disability

If any one of the qualified beneficiaries in your family is disabled and meets certain requirements, all of the qualified beneficiaries receiving continuation coverage due to a single qualifying event are entitled to an 11-month extension of the maximum period of continuation coverage (for a total maximum period of 29 months of continuation coverage). The plan can charge qualified beneficiaries an increased premium, up to 150 percent of the cost of coverage, during the 11-month disability extension.

The requirements are:

  1. that the Social Security Administration (SSA) determines that the disabled qualified beneficiary is disabled before the 60th day of continuation coverage; and
  2. that the disability continues during the rest of the 18-month period of continuation coverage. The disabled qualified beneficiary or another person on his or her behalf also must notify the plan of the SSA determination. The plan can set a time limit for providing this notice of disability, but the time limit cannot be shorter than 60 days, starting from the latest of: (1) the date on which SSA issues the disability determination; (2) the date on which the qualifying event occurs; (3) the date on which the qualified beneficiary loses (or would lose) coverage under the plan as a result of the qualifying event; or (4) the date on which the qualified beneficiary is informed, through the furnishing of the SPD or the COBRA general notice, of the responsibility to notify the plan and the procedures for doing so.

The right to the disability extension may be terminated if the SSA determines that the disabled qualified beneficiary is no longer disabled. The plan can require qualified beneficiaries receiving the disability extension to notify it if the SSA makes such a determination, although the plan must give the qualified beneficiaries at least 30 days after the SSA determination to do so.

The rules for how to give a disability notice and a notice of no longer being disabled should be described in the plan’s SPD (and in the election notice if you are offered an 18-month maximum period of continuation coverage).

Second Qualifying Event

If you are receiving an 18-month maximum period of continuation coverage, you may become entitled to an 18-month extension (giving a total maximum period of 36 months of continuation coverage) if you experience a second qualifying event that is the death of a covered employee, the divorce or legal separation of a covered employee and spouse, a covered employee’s becoming entitled to Medicare (in certain circumstances), or a loss of dependent child status under the plan. The second event can be a second qualifying event only if it would have caused you to lose coverage under the plan in the absence of the first qualifying event. If a second qualifying event occurs, you will need to notify the plan.

The rules for how to give notice of a second qualifying event should be described in the plan’s SPD (and in the election notice if you are offered an 18-month maximum period of continuation coverage). The plan can set a time limit for providing this notice, but the time limit cannot be shorter than 60 days from the latest of: (1) the date on which the qualifying event occurs; (2) the date on which you lose (or would lose) coverage under the plan as a result of the qualifying event; or (3) the date on which you are informed, through the furnishing of either the SPD or the COBRA general notice, of the responsibility to notify the plan and the procedures for doing so.

Can COBRA continuation coverage be terminated early for any reason?

A group health plan may terminate coverage earlier than the end of the maximum period for any of the following reasons:

  • Premiums are not paid in full on a timely basis;
  • The employer ceases to maintain any group health plan;
  • A qualified beneficiary begins coverage under another group health plan after electing continuation coverage;
  • A qualified beneficiary becomes entitled to Medicare benefits after electing continuation coverage; or
  • A qualified beneficiary engages in conduct that would justify the plan in terminating coverage of a similarly situated participant or beneficiary not receiving continuation coverage (such as fraud).

If continuation coverage is terminated early, the plan must provide the qualified beneficiary with an early termination notice. The notice must be given as soon as practicable after the decision is made, and it must describe the date coverage will terminate, the reason for termination, and any rights the qualified beneficiary may have under the plan or applicable law to elect alternative group or individual coverage.

If you decide to terminate your COBRA coverage early, you generally won’t be able to get a Marketplace plan outside of the open enrollment period. For more information on alternatives to COBRA coverage, see question: ‘If I waive COBRA coverage during the election period, can I still get coverage at a later date?‘.

 

How long does COBRA coverage last?

COBRA requires that continuation coverage extend from the date of the qualifying event for a limited period of 18 or 36 months. The length of time depends on the type of qualifying event that gave rise to the COBRA rights.

When the qualifying event is the covered employees/retirees termination of employment or reduction in hours of employment, qualified beneficiaries are entitled to 18 months of continuation coverage.

When the qualifying event is the end of employment or reduction of the employee’s hours, and the employee became entitled to Medicare less than 18 months before the qualifying event, COBRA coverage for the employee’s spouse and dependents can last until 36 months after the date the employee becomes entitled to Medicare.

For other qualifying events, qualified beneficiaries must be provided 36 months of continuation coverage.

Under COBRA, what benefits must be covered?

If you elect continuation coverage, the coverage you are given must be identical to the coverage currently available under the plan to similarly situated employees/retirees and their families (generally, this is the same coverage that you had immediately before the qualifying event). You will also be entitled, while receiving continuation coverage, to the same benefits, choices, and services that a similarly situated participant or beneficiary is currently receiving under the plan, such as the right during open enrollment season to choose among available coverage options.

If I waive COBRA coverage during the election period, can I still get coverage at a later date?

If you waive COBRA coverage during the election period, you will only be permitted to revoke your waiver of coverage and to elect continuation coverage as long as you do so within the 60 day election period. Then, the plan need only provide continuation coverage beginning on the date you revoke the waiver.

How long do I have to elect COBRA coverage?

If you are entitled to elect COBRA coverage, you must be given an election period of at least 60 days to choose whether or not to elect continuation coverage.

What are some examples of qualifying events?

Qualifying events eligible for COBRA continuation of coverage include:

  • Death of a covered employee (if dependents not eligible for survivor benefits)
  • Termination of employment for reasons other than gross misconduct
  • Reduction in work hours
  • Covered employee’s becoming entitled to Medicare
  • Divorce or legal separation of a covered employee and spouse
  • A child’s loss of dependent status (and therefore coverage) under the plan

View all COBRA qualifying events.

How do I become eligible for COBRA continuation coverage?

To be eligible for COBRA coverage, you must have been enrolled in your employer’s health plan when you worked and the health plan must continue to be in effect for employees/retirees. COBRA continuation coverage is available upon the occurrence of a qualifying event that would, except for the COBRA continuation coverage, cause an individual to lose his or her health care coverage.

EUTF HSTA 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-1 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 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-1 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-1. 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-1 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-1 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-1 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-1 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.

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.

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.

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.

EUTF Retiree

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

You need to complete an EC-2 and submit to the EUTF 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 am getting married and want to add my spouse, what do I need to do?

You need to submit an EC-2 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 of marriage or the first day of the first pay period after the date of marriage, or the first day of the 2nd pay period after the date of marriage for all plans except UnitedHealthcare’s Medicare Advantage Plan. For UnitedHealthCare’s Medicare Advantage Plan the effective date of of your new spouse’s coverage is the first of the month following the signature date on the EC-2 Enrollment form. Also, your new spouse must be enrolled in Medicare Parts A & B at the time of enrollment.

My dependent lost coverage from a non-EUTF plan and I wish to enroll him/her under my EUTF plan, what do I need to do?

You need to submit an EC-2 form within 30 days from loss of other coverage and include a loss of coverage letter from the previous employer/carrier detailing the type of coverage lost (i.e. medical, dental, drug, vision), date of loss of coverage, and names of any covered dependents. Also include a copy of dependent’s Medicare Part A & B card if eligible to enroll. You can add your spouse to your current plans – you cannot change plans. The effective date of coverage is the date of dependent’s loss of coverage in a non-EUTF plan for all plans except UnitedHealthcare’s Medicare Advantage Plan. For UnitedHealthCare’s Medicare Advantage Plan the effective date of coverage is the first of the month following the signature date on the EC-2 Enrollment Form. Also, the dependent must be enrolled in Medicare Parts A and B.

I am getting divorced, what do I need to do?

You need to submit an EC-2 form within 30 days of the date of divorce and include pages 1 and 2 of the divorce decree along with the signature page. If children are involved you need to include those pages that outline health benefits for children. The effective date of termination of coverage for your ex-spouse is the first day of the first pay period following the divorce.

My spouse has passed away, what do I need to do?

You need to submit an EC-2 form as soon as reasonably practical and include a death certificate or copy of obituary as soon as available. The effective date of termination of coverage is the date of death.

I wish to cancel EUTF plans due to acquiring coverage through a non-EUTF plan, what do I need to do?

You need to submit an EC-2 form within 30 days from the effective date of acquiring coverage elsewhere. Your effective termination date of coverage is the end of the pay period in which you acquire coverage from a non-EUTF plan, except when you acquire coverage from the non-EUTF plan on the first or 16th of the month, in which case coverage ends at the end of the prior pay period.

What and when is open enrollment?

Open Enrollment is your only opportunity to make changes 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 sent a Retiree Reference Guide which will notify you of the upcoming Open Enrollment period.  Please make sure that your address is up to date so that you don’t miss out on this and other EUTF communications.  Open Enrollment is scheduled from October 12 – October 30, 2015 for plan changes taking effect on January 1, 2016.

How and when will I be reimbursed for my Medicare Part B premiums?

The following must be submitted to the EUTF to receive reimbursement of Medicare Part B premium:

  1. Copy of your Medicare card showing enrollment in Medicare Part B;
  2. Medicare Part B Premium Reimbursement Request and Direct Deposit Agreement Form, and
  3. If you pay more than the standard Medicare Part B premium, a copy of the letter you receive from the Social Security Administration indicating the amount of your monthly Medicare Part B premium.

Under current law, the amount of your Medicare Part B reimbursement is the amount you are charged by Medicare (minus any penalties for late enrollment). Generally, your reimbursement will be deposited quarterly during the first week of April, July, October and January for the prior quarter. If you became eligible for Medicare Part B after July 1, 2006, your reimbursements must be direct deposited into your financial institution account. A direct deposit agreement form must be submitted to the EUTF.

Why am I required to enroll in Medicare Part B when I am eligible?

The requirement for all State and County retirees and dependents to enroll in Medicare Part B was set forth in Act 88, 2001 Session Laws of Hawaii. This Act created Chapter 87A, Hawaii Revised Statutes (HRS), which includes the following statute:

Section 87A-23(4): “All employee-beneficiaries or dependent-beneficiaries who are eligible to enroll in the Medicare Part B medical insurance plan shall enroll in that plan as a condition of receiving contributions and participating in benefits plans under this chapter. This paragraph shall apply to retired employees, their spouses or, and the surviving spouses of deceased retirees and employees killed in the performance of duty;”

How much will I pay for my retiree coverage?

The amount of the employer premium contribution is determined by statute and is based on three factors:

  • The date the employee was hired
  • The length of service taking into account breaks in service, and
  • The Base Monthly Contribution (BMC) amount which determines the amount the employer will contribute towards your retiree medical, prescription drug, dental, and vision coverage.

The BMC increases annually at the same rate as Medicare Part B premiums.

Years of Credited Service (Excluding Sick Leave)State's BMC if You Were Hired On or Before 6/30/1996State's BMC if You Were Hired On or Between 7/1/1996 - 6/30/01*State's BMC if You Were Hired On or After 7/1/2001
Less than 10 years50%0%0%
10 years but less than 15100%50%50%
15 years but less than 25100%75%75%
25 years or more100%100%100%

*The Employer’s percentage of the BMC determines the employer contribution. Any difference between the employer contribution and total premium for plans selected will be paid by the retiree.

Should the total premiums for medical, prescription drug, dental and vision coverage exceed the BMC, the retiree in a 100% tier will likely have to contribute a portion of their retiree premiums.

Who is eligible for retiree health benefits?

As a state or county retiree, you are eligible to enroll:

  • Yourself
  • Your spouse, domestic partner (DP), or civil union partner (CUP)
  • Your children under age 19.  Children under age 24 if unmarried and full-time student.  Dependent children include those by birth, marriage, stepchild, adoption or placement for adoption
  • Your child, regardless of age, who is incapable of self-support because of a mental or physical impairment that existed prior to the child reaching age 19.

In addition the following persons are eligible for Retiree health benefits:

  • The surviving spouse of an employee killed in the performance of the employee’s duty, provided he or she does not enter into another marriage or domestic partnership.
  • The surviving spouse of a deceased retiree or a deceased employee who at the time of death was eligible for retirement, provided he or she does not enter into another marriage or domestic partnership.
  • The unmarried child of a deceased retired employee, provided the child is under age 19 with no surviving parent who is eligible to be covered as a surviving spouse.

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.

HSTA VB Retiree

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

You need to complete an EC-2/EC-2H and submit to the EUTF within 180 days of the child’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 am getting married and want to add my spouse, what do I need to do?

You need to submit an EC-2H 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 of marriage or the first day of the first pay period after the date of marriage, or the first day of the 2nd pay period after the date of marriage for all plans. Also, your new spouse must be enrolled in Medicare Parts A & B at the time of enrollment.

My dependent lost coverage from a non-EUTF plan and I wish to enroll him/her under my EUTF plan, what do I need to do?

You need to submit an EC-2H form within 30 days from loss of other coverage and include a loss of coverage letter from the previous employer/carrier detailing the type of coverage lost (i.e. medical, dental, drug, vision), date of loss of coverage, and names of any covered dependents. Also include a copy of dependent’s Medicare Part A & B card if eligible to enroll. You can add your spouse to your current plans – you cannot change plans. The effective date of coverage is the date of dependent’s loss of coverage in a non-EUTF plan. Also, the dependent must be enrolled in Medicare Parts A and B.

I am getting divorced, what do I need to do?

You need to submit an EC-2H form within 30 days of the date of divorce and include pages 1 and 2 of the divorce decree along with the signature page. If children are involved you need to include those pages that outline health benefits for children. The effective date of termination of coverage for your ex-spouse is the first day of the first pay period following the divorce.

My spouse has passed away, what do I need to do?

You need to submit an EC-2H form as soon as reasonably practical and include a death certificate or copy of obituary as soon as available. The effective date of termination of coverage is the date of death.

I wish to cancel EUTF plans due to acquiring coverage through a non-EUTF plan, what do I need to do?

You need to submit an EC-2H form within 30 days from the effective date of acquiring coverage elsewhere. Your effective termination date of coverage is the end of the pay period in which you acquire coverage from a non-EUTF plan, except when you acquire coverage from the non-EUTF plan on the first or 16th of the month, in which case coverage ends at the end of the prior pay period.

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.

What and when is open enrollment?

Open Enrollment is your only opportunity to make changes 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 sent a Retiree Reference Guide which will notify you of the upcoming Open Enrollment period.  Please make sure that your address is up to date so that you don’t miss out on this and other EUTF communications.  Open Enrollment is scheduled from October 12 – October 30, 2015 for plan changes taking effect on January 1, 2016.

How and when will I be reimbursed for my Medicare Part B premiums?

The following must be submitted to the EUTF to receive reimbursement of Medicare Part B premium:

  1. Copy of your Medicare card showing enrollment in Medicare Part B;
  2. Medicare Part B Premium Reimbursement Request and Direct Deposit Agreement Form, and
  3. If you pay more than the standard Medicare Part B premium, a copy of the letter you receive from the Social Security Administration indicating the amount of your monthly Medicare Part B premium.

Under current law, the amount of your Medicare Part B reimbursement is the amount you are charged by Medicare (minus any penalties for late enrollment). Generally, your reimbursement will be deposited quarterly during the first week of April, July, October and January for the prior quarter. If you became eligible for Medicare Part B after July 1, 2006, your reimbursements must be direct deposited into your financial institution account. A direct deposit agreement form must be submitted to the EUTF.

Why am I required to enroll in Medicare Part B when I am eligible?

The requirement for all State and County retirees and dependents to enroll in Medicare Part B was set forth in Act 88, 2001 Session Laws of Hawaii. This Act created Chapter 87A, Hawaii Revised Statutes (HRS), which includes the following statute:

Section 87A-23(4): “All employee-beneficiaries or dependent-beneficiaries who are eligible to enroll in the Medicare Part B medical insurance plan shall enroll in that plan as a condition of receiving contributions and participating in benefits plans under this chapter. This paragraph shall apply to retired employees, their spouses or, and the surviving spouses of deceased retirees and employees killed in the performance of duty;”

How much will I pay for my retiree coverage?

The amount of the employer premium contribution is determined by statute and is based on three factors:

  • The date the employee was hired
  • The length of service taking into account breaks in service, and
  • The Base Monthly Contribution (BMC) amount which determines the amount the employer will contribute towards your retiree medical, prescription drug, dental, and vision coverage.

The BMC increases annually at the same rate as Medicare Part B premiums.

Years of Credited Service (Excluding Sick Leave)State's BMC if You Were Hired On or Before 6/30/1996State's BMC if You Were Hired On or Between 7/1/1996 - 6/30/01*State's BMC if You Were Hired On or After 7/1/2001
Less than 10 years50%0%0%
10 years but less than 15100%50%50%
15 years but less than 25100%75%75%
25 years or more100%100%100%

*The Employer’s percentage of the BMC determines the employer contribution. Any difference between the employer contribution and total premium for plans selected will be paid by the retiree.

Should the total premiums for medical, prescription drug, dental and vision coverage exceed the BMC, the retiree in a 100% tier will likely have to contribute a portion of their retiree premiums.

Who is eligible for retiree health benefits?

As a state or county retiree, you are eligible to enroll:

  • Yourself
  • Your spouse, domestic partner (DP), or civil union partner (CUP)
  • Your children under age 19.  Children under age 24 if unmarried and full-time student.  Dependent children include those by birth, marriage, stepchild, adoption or placement for adoption
  • Your child, regardless of age, who is incapable of self-support because of a mental or physical impairment that existed prior to the child reaching age 19.

In addition the following persons are eligible for Retiree health benefits:

  • The surviving spouse of an employee killed in the performance of the employee’s duty, provided he or she does not enter into another marriage or domestic partnership.
  • The surviving spouse of a deceased retiree or a deceased employee who at the time of death was eligible for retirement, provided he or she does not enter into another marriage or domestic partnership.
  • The unmarried child of a deceased retired employee, provided the child is under age 19 with no surviving parent who is eligible to be covered as a surviving spouse.