Medicare – FAQs

EUTF Active

My child is/will be attending college. What do I need to submit to the EUTF to confirm they are a full-time student?

Acceptable forms of student certification include:

  • Signed letter from the school’s registrar written on the school’s letterhead indicating full-time student status
  • Student enrollment verification form from www.studentclearninghouse.org

Copies of a class schedule, payment or tuition, or similar documents will not be accepted.

The EUTF will mail a courtesy reminder letter two months prior to your dependent’s birthday.  Student certification must be submitted to the EUTF within 15 days of the dependent’s birthday in order to avoid termination of their dental and/or vision plans.  If EUTF does not receive student certification prior to the end date listed on the courtesy reminder, a COBRA Election Notice will generate and coverage will stop at the end of that pay period.  In order to maintain enrollment, student certification must be renewed annually.

EUTF Administrative Rules 1.02 and 5.05(b) specify that dependent-beneficiaries ages 19 through 23 who are full-time students may enroll in dental and/or vision plans.  Children may be enrolled in medical and prescription drug plans until age 26 regardless of whether they are a full-time student or not.

I’m a new State or County employee and want to learn more about my health plan options. Is there educational material available?

Yes.  An on-demand video is available that covers enrollment procedures, eligibility criteria and a summary of EUTF health plan options and other benefits.  For more information, you can also download the EUTF New Hire Enrollment Guide.

Why did I receive a COBRA General Notice in the mail?

You will receive a COBRA General Notice if you make changes to your plan enrollment.  This notice contains information about your right to COBRA continuation coverage, which is a temporary extension of coverage under EUTF plans when coverage under the plan would normally cease.  This notice generally explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it.  For more information on COBRA, click here.

Why did I receive a COBRA Election Notice?

The COBRA Election Notice offers employees and/or their dependents temporary continuation of their health plan coverage when their coverage would otherwise end because of certain qualifying events (i.e., end of employment, child ceasing to be an eligible dependent child, etc.).  The maximum period of COBRA coverage is generally either 18 or 36 months, depending on which qualifying event occurred.  To watch a short overview on COBRA, click here.

Who is eligible for active employee 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 or domestic partner
  • Your children under age 26 for medical and prescription drug coverage.  This includes children by birth, marriage, adoption, placement for adoption or foster child.  For dental and vision coverage, dependent children under age 19, and from age 19 through age 23 if they are unmarried and a full-time student.  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 not eligible for the EUTF health plans should contact their departmental human resources or personnel office for more information.

I’m having a baby. What do I need to do to enroll my baby in my health plans?

Complete an EC-1 enrollment form (or EC-1H for HSTA VB members) and submit it to your departmental human resources office or enrollment designee within 180 days of the baby’s birthday.  For DOE employees, you must submit your form to:

DOE-EBU
PO Box 2360
Honolulu, HI 96804

A copy of the birth certificate is required only if the child has a different last name than you.  You can add your baby to your current plans – you cannot change plans.  Please submit your child’s Social Security Number to the EUTF once it’s issued by the Social Security Administration.  For more information, please see the Newborn Checklist.

If I have a baby, can I also enroll my spouse/partner to the plan?

Yes.  To enroll your spouse/partner, add their information to the EC-1 enrollment form (or EC-1H for HSTA VB members) and submit it to your departmental human resources office or enrollment designee within 180 days of the baby’s birthday.  For DOE employees, you must submit your form to:

DOE-EBU
PO Box 2360
Honolulu, HI 96804

If you are enrolling your spouse/partner for the first time in EUTF plans, please submit a copy of your marriage certificate or domestic partnership documents. You can add your spouse to your current plans – you cannot change plans.

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

Complete an EC-1 enrollment form (or EC-1H for HSTA VB members) and submit it to your departmental human resources office or enrollment designee within 30 days of your marriage date.  For DOE employees, you must submit your form to:

DOE-EBU
PO Box 2360
Honolulu, HI 96804

Attach a copy of your marriage certificate or if it’s not available within 30 days, send it to the EUTF within 60 days of your marriage date.  You can add your spouse to your current plans – you cannot change plans.

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

Complete an EC-1 enrollment form (or EC-1H for HSTA VB members) and submit it to your departmental human resources office or enrollment designee within 30 days of your loss of coverage under your spouse’s plan.  For DOE employees, you must submit your form to:

DOE-EBU
PO Box 2360
Honolulu, HI 96804

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?

Employees must terminate their spouse’s/partner’s coverage within 30 days of the date of divorce.  Complete an EC-1 enrollment form (or EC-1H for HSTA VB members) and submit it to your departmental human resources office or enrollment designee within 30 days of your divorce date to terminate your spouse’s coverage.  For DOE employees, you must submit your form to:

DOE-EBU
PO Box 2360
Honolulu, HI 96804

Attach pages 1 and 2 of the divorce decree along with the signature page.  If the EC-1/EC-1H is filed more than 60 days after the date of divorce, the employee will be responsible for paying the employer contribution of premiums retroactive to the divorce date.  Your former spouse’s coverage ends the first date of the first pay period following the divorce.

I was covered under my spouse’s health insurance and we recently lost our coverage. Can I enroll into my EUTF coverage right away?

Yes.  Complete an EC-1 enrollment form (or EC-1H for HSTA VB members) and submit it to your departmental human resources office or enrollment designee within 30 days from the date you lost coverage under your spouse’s plan.  For DOE employees, you must submit your form to:

DOE-EBU
PO Box 2360
Honolulu, HI 96804

Attach a loss of coverage letter from your 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 spouse’s plan.

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

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

  1. Cancel your health benefit plan enrollment during your leave of absence.
    • You must complete an EC-1 enrollment form (or EC-1H for HSTA VB members) within 30 days from your authorized leave date to cancel coverage, and may enroll in the same health plans upon return from leave by submitting an EC-1/EC-1H form within 30 days from your return date. The effective date of the cancellation will be the first day of the first pay period following your LWOP start date.
  2. Continue all your plans during your leave of absence by paying the premiums due by the end of the month.
    • Employees are responsible for submitting premium payments to the EUTF by check, electronic check, credit card or ACH payment. For more information on premium payment options, please click here.

If you do not submit an EC-1/EC-1H enrolment form within 30 days to cancel your coverage and do not make payment to the EUTF, your plans will be cancelled due to non-payment.  You may enroll during the next open enrollment or if you experience a qualifying life event.

If you are on leave without pay for a period less than 30 days, you could still have a premium shortage.  Employees on leave should check their paystub to see if they need to submit a premium payment to the EUTF.

For employees on Family Medical Leave of Absence without pay:  If you continue plans but do not submit payment to the EUTF by the due date indicated on the Shortage notice, your plans will be cancelled effective the due date on the notice.

For Uniformed Services Employment and Reemployment Rights Act (USERRA): If you continue plans but do not submit payment to the EUTF by the due date indicated on the shortage notice, your plans will be cancelled retroactive to your leave of absence date.

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.

Complete an EC-1 enrollment form (or EC-1H for HSTA VB members) and submit it to your departmental human resources office or enrollment designee within 30 days to remove your dependent from your EUTF plans.  For DOE employees, you must submit your form to:

DOE-EBU
PO Box 2360
Honolulu, HI 96804

Your dependent will be terminated the first day of the first pay period following their loss of eligibility.  If the EC-1/EC-1H is filed more than 60 days after the date of divorce/partnership, the employee shall be responsible for paying the employer contribution of premiums retroactive to the divorce date.

My child is no longer eligible (i.e., graduated from college, is no longer a full-time student, 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.  This does not apply to medical and prescription drug coverage, which they may remain enrolled in to age 26.

Complete an EC-1 enrollment form (or EC-1H for HSTA VB members) and submit it to your departmental human resources office or enrollment designee within 30 days to remove your dependent from your EUTF plans.  For DOE employees, you must submit your form to:

DOE-EBU
PO Box 2360
Honolulu, HI 96804

Your child will be terminated the first day of the first pay period following their loss of eligibility.

How do I change my address?

Complete an Employee Address Change Form and submit it to your departmental human resources office or enrollment designee as soon as possible. For DOE employees, you must submit your form to:

DOE-EBU
PO Box 2360
Honolulu, HI 96804

The EUTF will process your change of address and notify each of the health plan carriers.   Be advised that all address changes must go through the EUTF and not to the health plan carriers directly.

Will I get new health plan ID cards every year?

No.  ID cards are only issued for new enrollments or when you make changes to your plan enrollment.  ID cards are not issued for HMA, American Specialties Health Group Inc., and VSP, as ID cards are not required to receive services.

Where can I get more information on EUTF plan options for active employees, enrollment procedures and eligibility criteria?

The EUTF Reference Guide for Active Employees is published annually and contains information on enrollment and eligibility, premiums and contributions, health plan options and how to make changes to your plans.  To download the guide, click here and select the Reference Guide you wish to view.

Does EUTF offer the Island Flex Plan?

No.  For State employees, the Island Flex Plan is administered by the State Department of Human Resources Development (DHRD).  For more information, please visit the website of the plan’s third-party administrator, Comprehensive Financial Planning, Inc. at http://www.CompFinPlan.com.  For County employees, contact your personnel office for more information.

Where can I get more information on the Premium Conversion Plan?

For State employees, the Premium Conversion Plan (PCP) is a voluntary benefit plan, administered by the State Department of Human Resources Development (DHRD) that allows 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 click here.  For County employees, contact your personnel office for more information.

I’m an active employee considering retirement. Where can I learn more about what is needed to enroll in EUTF retiree plans?

Sign-up to attend a pre-retirement health benefits workshop, watch an on-demand pre-retirement informational video, or view the Pre-retirement Checklist and Medicare Checklist.

If I’m killed in the performance of duty, what will happen to my family’s health coverage?

The surviving spouse/partner of an employee killed in the performance of duty is eligible to enroll in retiree plans, provided the spouse or partner does not remarry or enter into another domestic or civil union partnership.  Additionally, the unmarried child of an employee killed in the performance of duty is eligible to be enrolled in retiree plans, provided the child is under the limiting age, as defined in the EUTF Administrative Rule 1.02 or is an adult disabled child in accordance with the EUTF Administrative Rule 3.01(b)(3) and does not have a surviving parent who is eligible to be an employee-beneficiary.

If I die before I retire, is my spouse/partner eligible for EUTF health coverage?

The surviving spouse/partner and/or unmarried child of a deceased employee is eligible to enroll in EUTF retiree plans provided the deceased employee was eligible on his/her date of death to retire with the Employees’ Retirement System (ERS).  In order to continue enrollment in EUTF retiree plans, the surviving spouse/partner may not remarry or enter into another domestic or civil union partnership.  The surviving child of a deceased employee is eligible to enroll in retiree plans provided the child is under the age of 19 and does not have a surviving parent who is eligible to be an employee-beneficiary.

EUTF Retiree

I’ve recently retired and enrolled in EUTF retiree health plans. Why am I receiving COBRA Continuation of Benefits Enrollment material?

For retirees who were enrolled in EUTF Active plans at the time of their retirement, once the EUTF receives an EC-1 form from your employer to terminate your active coverage, you will receive a COBRA Continuation of Coverage Election Notice from the EUTF.  COBRA allows you to continue some or all of your Active EUTF health plans.  Keep in mind that if you elect COBRA, you will be responsible for 110% of the premium cost.  The EUTF is required by federal law to offer COBRA to members who terminate EUTF health plans.

Click for more information about COBRA for retirees.

I am enrolled in EUTF retiree health plans and will be eligible for Medicare in a few months. What do I need to do?

The Hawaii Revised Statutes 87A-23(4) requires that State and County retirees and their eligible dependents who are enrolled in EUTF retiree medical and/or prescription drug benefit plans, must be enrolled in Medicare Part B when they become eligible.  Please provide proof of Medicare Part B enrollment to the EUTF within 60 days of becoming eligible.  If you and/or your covered dependent(s) are Medicare eligible and covered under EUTF retiree medical and/or prescription drug plans you must submit a copy of your and/or your dependent’s Medicare card (indicating enrollment into Medicare Part B), Medicare Part B Reimbursement Direct Deposit Agreement Form, and Social Security Administration letter for you and/or your dependent indicating the Medicare Part B Premium amount.  If you do not provide proof of Medicare Part B enrollment to the EUTF within 60 days of becoming eligible, your and/or your dependent’s EUTF retiree medical and/or prescription drug plans will be cancelled.

Click for a copy of the EUTF Medicare Checklist.

I pay a monthly premium for my EUTF retiree health plans. What are my premium payment options other than mailing in my payment to the EUTF?

If you are currently paying your healthcare premiums via check to the EUTF, you now have four other payment options:

  1. Premiums automatically deducted each month from your Employees’ Retirement System (ERS) pension.
  2. Monthly reoccurring electronic transfers from your bank account initiated and adjusted by the EUTF.
  3. Credit card for a fee of $2.50 plus 2.25% of the premium amount.
  4. Electronic transfers from your bank account that you initiate for a fee of $3.50 per transaction.

Click to initiate payment transactions or for more information.

How do I change my address?

Retirees may complete and submit a Retiree Address Change Form.  Once the Retiree Address Change Form is received, the EUTF will notify the health carriers of your new address. Be advised that all address changes must go through the EUTF, as health plan carriers are not able to make changes.

Where can I get more information on EUTF plan options for retirees, enrollment procedures and eligibility criteria?

The Health Benefits Retiree Reference Guide is published annually and mailed to retirees in the Fall.  The Reference Guide contains information on EUTF policies and procedures, enrollment and eligibility, employer contribution, health plan options, the EC-2 enrollment form, and Common Qualifying Events chart.

Do I need to turn in my Income-Related Monthly Adjustment Amount (IRMAA) to get reimbursement for Medicare Part B?

Yes.  The EUTF will need a copy of your Medicare card, Direct Deposit Agreement Form, and Social Security Administration letter indicating your Medicare Part B premium or IRMAA.  EUTF will automatically reset your Medicare Part B premium reimbursement to the Medicare standard amount every January 1st. If you are paying above the Medicare standard amount you must submit a letter from the Social Security Administration indicating the amount you are paying every year to receive full reimbursement.

Will I be reimbursed for Medicare Part D premiums if I’m being charged by Social Security?

No, EUTF is not authorized under Hawaii Revised Statutes 87A to reimburse Medicare Part D premiums.

Can I change plans if I move out of the coverage area?

You may change plans if you are enrolled in the EUTF retiree Kaiser plan and move out of the service area. You have 30 days to notify EUTF and may switch to the HMSA 90/10 plan.  Please complete an EC-2 enrollment form (or EC-2H for HSTA VB members) and submit it to the EUTF within 30 days of moving out of the coverage area.

Does my spouse or I need to be covered under an EUTF active employee plan at the time of retirement to be eligible to enroll in the EUTF retiree plans?

No, you do not need to be enrolled in Active plans for any amount of time or be enrolled in the EUTF Active plan at all to qualify for EUTF retiree benefits.

If I retire from the State or County and later return to work for the State or County, do I need to notify the EUTF?

Yes, if you return to work full-time for the State or County you must notify the EUTF to stop your EUTF retiree plans and you may enroll in EUTF Active plans.  If you return to work part-time or outside of the State or County, this does not apply to you.

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

Retirees must terminate their spouse’s/partner’s coverage within 30 days of the date of divorce.  Complete an EC-2 enrollment form (or EC-2H for HSTA VB members) and submit it to the EUTF within 30 days of your divorce date to terminate your spouse’s coverage.  Attach pages 1 and 2 of the divorce decree, along with the signature page.

If the EC-2/EC-2H is filed more than 60 days after the date of divorce, the retiree will be responsible for paying the employer contribution of premiums retroactive to the divorce date.

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

Complete an EC-2 enrollment form (or EC-2H for HSTA VB members) and submit it to the EUTF within 30 days of your marriage date.  Attach a copy of your marriage certificate or if it’s not available within 30 days, send it to the EUTF within 60 days of your marriage date.  You can add your spouse to your current plans – you cannot change plans.

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.

Complete an EC-2 enrollment form (or EC-2H for HSTA VB members) and submit it to the EUTF within 30 days to remove your dependent from your EUTF plans.  If the EC-2/EC-2H is filed more than 60 days after the date of divorce/partnership, the retiree shall be responsible for paying the employer contribution of premiums retroactive to the divorce date.

My child is no longer eligible (i.e., graduated from college, no longer a full-time student, etc.), but is under the age of 24. Do I need to notify the EUTF?

You must notify the EUTF and terminate your child’s medical, prescription drug, dental and vision coverage within 30 days from when they become ineligible.

Complete an EC-2 enrollment form (or EC-2H for HSTA VB members) and submit it to the EUTF within 30 days to remove your dependent from your EUTF plans.

My spouse passed away. What do I need to do?

Please see the Death checklist for more information.

What and when is open enrollment?

Open Enrollment is your opportunity to make changes to your plan enrollment.  During Open Enrollment you can:

  • Add, change or cancel plans
  • Add or remove dependents
  • Change coverage tiers such as changing from single to family, or family to two party

You will be mailed a Retiree Reference Guide which will notify you of the upcoming Open Enrollment period.  Please make sure that your address is current so that you don’t miss out on this and other EUTF communications.  Open Enrollment usually takes place in the month of October and plan and premium changes become effective Jan. 1st.

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

The following must be submitted to the EUTF in order to receive reimbursement of Medicare Part B premiums:

  1. Copy of your Medicare card indicating enrollment in Medicare Part B
  2. Medicare Part B Premium Reimbursement Request and Direct Deposit Agreement Form
  3. Social Security Administration letter 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). Generally, your reimbursement will be deposited quarterly during the first week of April, July, October and January for the prior quarter.

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;”

Who is eligible for retiree health benefits?

As a State or County retiree, you are eligible to enroll:

  • Yourself
  • Your spouse, or domestic or civil union partner
  • Your children under age 19.  Children under age 24 if unmarried and a full-time student.  Dependent children include those by birth, marriage, foster, 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

General

When should I apply for Medicare?

Medicare eligible retirees must enroll in Medicare Part B to continue to be covered under an EUTF retiree medical and/or prescription drug plan.  A spouse/civil union or domestic partner who is enrolled as a dependent under an EUTF retiree medical and/or prescription drug plan must also enroll in Medicare Part B when they become eligible for Medicare, regardless of whether they are retired or actively employed.

Retirees who are less than 65 years old:  Contact Social Security three months prior to your 65th birthday.

Retirees who are 65 at the time of retirement: Contact Social Security to enroll three months prior to your retirement date.

HSTA VB Active

My child is/will be attending college. What do I need to submit to the EUTF to confirm they are a full-time student?

Acceptable forms of student certification include:

  • Signed letter from the school’s registrar written on the school’s letterhead indicating full-time student status
  • Student enrollment verification form from www.studentclearninghouse.org

Copies of a class schedule, payment or tuition, or similar documents will not be accepted.

The EUTF will mail a courtesy reminder letter two months prior to your dependent’s birthday.  Student certification must be submitted to the EUTF within 15 days of the dependent’s birthday in order to avoid termination of their dental and/or vision plans.  If EUTF does not receive student certification prior to the end date listed on the courtesy reminder, a COBRA Election Notice will generate and coverage will stop at the end of that pay period.  In order to maintain enrollment, student certification must be renewed annually.

EUTF Administrative Rules 1.02 and 5.05(b) specify that dependent-beneficiaries ages 19 through 23 who are full-time students may enroll in dental and/or vision plans.  Children may be enrolled in medical and prescription drug plans until age 26 regardless of whether they are a full-time student or not.

I’m a new State or County employee and want to learn more about my health plan options. Is there educational material available?

Yes.  An on-demand video is available that covers enrollment procedures, eligibility criteria and a summary of EUTF health plan options and other benefits.  For more information, you can also download the EUTF New Hire Enrollment Guide.

Why did I receive a COBRA General Notice in the mail?

You will receive a COBRA General Notice if you make changes to your plan enrollment.  This notice contains information about your right to COBRA continuation coverage, which is a temporary extension of coverage under EUTF plans when coverage under the plan would normally cease.  This notice generally explains COBRA continuation coverage, when it may become available to you and your family, and what you need to do to protect the right to receive it.  For more information on COBRA, click here.

Why did I receive a COBRA Election Notice?

The COBRA Election Notice offers employees and/or their dependents temporary continuation of their health plan coverage when their coverage would otherwise end because of certain qualifying events (i.e., end of employment, child ceasing to be an eligible dependent child, etc.).  The maximum period of COBRA coverage is generally either 18 or 36 months, depending on which qualifying event occurred.  To watch a short overview on COBRA, click here.

Who is eligible for active employee 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 or domestic partner
  • Your children under age 26 for medical and prescription drug coverage.  This includes children by birth, marriage, adoption, placement for adoption or foster child.  For dental and vision coverage, dependent children under age 19, and from age 19 through age 23 if they are unmarried and a full-time student.  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 not eligible for the EUTF health plans should contact their departmental human resources or personnel office for more information.

I’m having a baby. What do I need to do to enroll my baby in my health plans?

Complete an EC-1 enrollment form (or EC-1H for HSTA VB members) and submit it to your departmental human resources office or enrollment designee within 180 days of the baby’s birthday.  For DOE employees, you must submit your form to:

DOE-EBU
PO Box 2360
Honolulu, HI 96804

A copy of the birth certificate is required only if the child has a different last name than you.  You can add your baby to your current plans – you cannot change plans.  Please submit your child’s Social Security Number to the EUTF once it’s issued by the Social Security Administration.  For more information, please see the Newborn Checklist.

If I have a baby, can I also enroll my spouse/partner to the plan?

Yes.  To enroll your spouse/partner, add their information to the EC-1 enrollment form (or EC-1H for HSTA VB members) and submit it to your departmental human resources office or enrollment designee within 180 days of the baby’s birthday.  For DOE employees, you must submit your form to:

DOE-EBU
PO Box 2360
Honolulu, HI 96804

If you are enrolling your spouse/partner for the first time in EUTF plans, please submit a copy of your marriage certificate or domestic partnership documents. You can add your spouse to your current plans – you cannot change plans.

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

Complete an EC-1 enrollment form (or EC-1H for HSTA VB members) and submit it to your departmental human resources office or enrollment designee within 30 days of your marriage date.  For DOE employees, you must submit your form to:

DOE-EBU
PO Box 2360
Honolulu, HI 96804

Attach a copy of your marriage certificate or if it’s not available within 30 days, send it to the EUTF within 60 days of your marriage date.  You can add your spouse to your current plans – you cannot change plans.

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

Complete an EC-1 enrollment form (or EC-1H for HSTA VB members) and submit it to your departmental human resources office or enrollment designee within 30 days of your loss of coverage under your spouse’s plan.  For DOE employees, you must submit your form to:

DOE-EBU
PO Box 2360
Honolulu, HI 96804

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?

Employees must terminate their spouse’s/partner’s coverage within 30 days of the date of divorce.  Complete an EC-1 enrollment form (or EC-1H for HSTA VB members) and submit it to your departmental human resources office or enrollment designee within 30 days of your divorce date to terminate your spouse’s coverage.  For DOE employees, you must submit your form to:

DOE-EBU
PO Box 2360
Honolulu, HI 96804

Attach pages 1 and 2 of the divorce decree along with the signature page.  If the EC-1/EC-1H is filed more than 60 days after the date of divorce, the employee will be responsible for paying the employer contribution of premiums retroactive to the divorce date.  Your former spouse’s coverage ends the first date of the first pay period following the divorce.

I was covered under my spouse’s health insurance and we recently lost our coverage. Can I enroll into my EUTF coverage right away?

Yes.  Complete an EC-1 enrollment form (or EC-1H for HSTA VB members) and submit it to your departmental human resources office or enrollment designee within 30 days from the date you lost coverage under your spouse’s plan.  For DOE employees, you must submit your form to:

DOE-EBU
PO Box 2360
Honolulu, HI 96804

Attach a loss of coverage letter from your 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 spouse’s plan.

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

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

  1. Cancel your health benefit plan enrollment during your leave of absence.
    • You must complete an EC-1 enrollment form (or EC-1H for HSTA VB members) within 30 days from your authorized leave date to cancel coverage, and may enroll in the same health plans upon return from leave by submitting an EC-1/EC-1H form within 30 days from your return date. The effective date of the cancellation will be the first day of the first pay period following your LWOP start date.
  2. Continue all your plans during your leave of absence by paying the premiums due by the end of the month.
    • Employees are responsible for submitting premium payments to the EUTF by check, electronic check, credit card or ACH payment. For more information on premium payment options, please click here.

If you do not submit an EC-1/EC-1H enrolment form within 30 days to cancel your coverage and do not make payment to the EUTF, your plans will be cancelled due to non-payment.  You may enroll during the next open enrollment or if you experience a qualifying life event.

If you are on leave without pay for a period less than 30 days, you could still have a premium shortage.  Employees on leave should check their paystub to see if they need to submit a premium payment to the EUTF.

For employees on Family Medical Leave of Absence without pay:  If you continue plans but do not submit payment to the EUTF by the due date indicated on the Shortage notice, your plans will be cancelled effective the due date on the notice.

For Uniformed Services Employment and Reemployment Rights Act (USERRA): If you continue plans but do not submit payment to the EUTF by the due date indicated on the shortage notice, your plans will be cancelled retroactive to your leave of absence date.

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.

Complete an EC-1 enrollment form (or EC-1H for HSTA VB members) and submit it to your departmental human resources office or enrollment designee within 30 days to remove your dependent from your EUTF plans.  For DOE employees, you must submit your form to:

DOE-EBU
PO Box 2360
Honolulu, HI 96804

Your dependent will be terminated the first day of the first pay period following their loss of eligibility.  If the EC-1/EC-1H is filed more than 60 days after the date of divorce/partnership, the employee shall be responsible for paying the employer contribution of premiums retroactive to the divorce date.

My child is no longer eligible (i.e., graduated from college, is no longer a full-time student, 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.  This does not apply to medical and prescription drug coverage, which they may remain enrolled in to age 26.

Complete an EC-1 enrollment form (or EC-1H for HSTA VB members) and submit it to your departmental human resources office or enrollment designee within 30 days to remove your dependent from your EUTF plans.  For DOE employees, you must submit your form to:

DOE-EBU
PO Box 2360
Honolulu, HI 96804

Your child will be terminated the first day of the first pay period following their loss of eligibility.

How do I change my address?

Complete an Employee Address Change Form and submit it to your departmental human resources office or enrollment designee as soon as possible. For DOE employees, you must submit your form to:

DOE-EBU
PO Box 2360
Honolulu, HI 96804

The EUTF will process your change of address and notify each of the health plan carriers.   Be advised that all address changes must go through the EUTF and not to the health plan carriers directly.

Will I get new health plan ID cards every year?

No.  ID cards are only issued for new enrollments or when you make changes to your plan enrollment.  ID cards are not issued for HMA, American Specialties Health Group Inc., and VSP, as ID cards are not required to receive services.

Where can I get more information on EUTF plan options for active employees, enrollment procedures and eligibility criteria?

The EUTF Reference Guide for Active Employees is published annually and contains information on enrollment and eligibility, premiums and contributions, health plan options and how to make changes to your plans.  To download the guide, click here and select the Reference Guide you wish to view.

Does EUTF offer the Island Flex Plan?

No.  For State employees, the Island Flex Plan is administered by the State Department of Human Resources Development (DHRD).  For more information, please visit the website of the plan’s third-party administrator, Comprehensive Financial Planning, Inc. at http://www.CompFinPlan.com.  For County employees, contact your personnel office for more information.

Where can I get more information on the Premium Conversion Plan?

For State employees, the Premium Conversion Plan (PCP) is a voluntary benefit plan, administered by the State Department of Human Resources Development (DHRD) that allows 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 click here.  For County employees, contact your personnel office for more information.

I’m an active employee considering retirement. Where can I learn more about what is needed to enroll in EUTF retiree plans?

Sign-up to attend a pre-retirement health benefits workshop, watch an on-demand pre-retirement informational video, or view the Pre-retirement Checklist and Medicare Checklist.

If I’m killed in the performance of duty, what will happen to my family’s health coverage?

The surviving spouse/partner of an employee killed in the performance of duty is eligible to enroll in retiree plans, provided the spouse or partner does not remarry or enter into another domestic or civil union partnership.  Additionally, the unmarried child of an employee killed in the performance of duty is eligible to be enrolled in retiree plans, provided the child is under the limiting age, as defined in the EUTF Administrative Rule 1.02 or is an adult disabled child in accordance with the EUTF Administrative Rule 3.01(b)(3) and does not have a surviving parent who is eligible to be an employee-beneficiary.

If I die before I retire, is my spouse/partner eligible for EUTF health coverage?

The surviving spouse/partner and/or unmarried child of a deceased employee is eligible to enroll in EUTF retiree plans provided the deceased employee was eligible on his/her date of death to retire with the Employees’ Retirement System (ERS).  In order to continue enrollment in EUTF retiree plans, the surviving spouse/partner may not remarry or enter into another domestic or civil union partnership.  The surviving child of a deceased employee is eligible to enroll in retiree plans provided the child is under the age of 19 and does not have a surviving parent who is eligible to be an employee-beneficiary.

HSTA VB Retiree

I’ve recently retired and enrolled in EUTF retiree health plans. Why am I receiving COBRA Continuation of Benefits Enrollment material?

For retirees who were enrolled in EUTF Active plans at the time of their retirement, once the EUTF receives an EC-1 form from your employer to terminate your active coverage, you will receive a COBRA Continuation of Coverage Election Notice from the EUTF.  COBRA allows you to continue some or all of your Active EUTF health plans.  Keep in mind that if you elect COBRA, you will be responsible for 110% of the premium cost.  The EUTF is required by federal law to offer COBRA to members who terminate EUTF health plans.

Click for more information about COBRA for retirees.

I am enrolled in EUTF retiree health plans and will be eligible for Medicare in a few months. What do I need to do?

The Hawaii Revised Statutes 87A-23(4) requires that State and County retirees and their eligible dependents who are enrolled in EUTF retiree medical and/or prescription drug benefit plans, must be enrolled in Medicare Part B when they become eligible.  Please provide proof of Medicare Part B enrollment to the EUTF within 60 days of becoming eligible.  If you and/or your covered dependent(s) are Medicare eligible and covered under EUTF retiree medical and/or prescription drug plans you must submit a copy of your and/or your dependent’s Medicare card (indicating enrollment into Medicare Part B), Medicare Part B Reimbursement Direct Deposit Agreement Form, and Social Security Administration letter for you and/or your dependent indicating the Medicare Part B Premium amount.  If you do not provide proof of Medicare Part B enrollment to the EUTF within 60 days of becoming eligible, your and/or your dependent’s EUTF retiree medical and/or prescription drug plans will be cancelled.

Click for a copy of the EUTF Medicare Checklist.

I pay a monthly premium for my EUTF retiree health plans. What are my premium payment options other than mailing in my payment to the EUTF?

If you are currently paying your healthcare premiums via check to the EUTF, you now have four other payment options:

  1. Premiums automatically deducted each month from your Employees’ Retirement System (ERS) pension.
  2. Monthly reoccurring electronic transfers from your bank account initiated and adjusted by the EUTF.
  3. Credit card for a fee of $2.50 plus 2.25% of the premium amount.
  4. Electronic transfers from your bank account that you initiate for a fee of $3.50 per transaction.

Click to initiate payment transactions or for more information.

How do I change my address?

Retirees may complete and submit a Retiree Address Change Form.  Once the Retiree Address Change Form is received, the EUTF will notify the health carriers of your new address. Be advised that all address changes must go through the EUTF, as health plan carriers are not able to make changes.

Where can I get more information on EUTF plan options for retirees, enrollment procedures and eligibility criteria?

The Health Benefits Retiree Reference Guide is published annually and mailed to retirees in the Fall.  The Reference Guide contains information on EUTF policies and procedures, enrollment and eligibility, employer contribution, health plan options, the EC-2 enrollment form, and Common Qualifying Events chart.

Do I need to turn in my Income-Related Monthly Adjustment Amount (IRMAA) to get reimbursement for Medicare Part B?

Yes.  The EUTF will need a copy of your Medicare card, Direct Deposit Agreement Form, and Social Security Administration letter indicating your Medicare Part B premium or IRMAA.  EUTF will automatically reset your Medicare Part B premium reimbursement to the Medicare standard amount every January 1st. If you are paying above the Medicare standard amount you must submit a letter from the Social Security Administration indicating the amount you are paying every year to receive full reimbursement.

Will I be reimbursed for Medicare Part D premiums if I’m being charged by Social Security?

No, EUTF is not authorized under Hawaii Revised Statutes 87A to reimburse Medicare Part D premiums.

Can I change plans if I move out of the coverage area?

You may change plans if you are enrolled in the EUTF retiree Kaiser plan and move out of the service area. You have 30 days to notify EUTF and may switch to the HMSA 90/10 plan.  Please complete an EC-2 enrollment form (or EC-2H for HSTA VB members) and submit it to the EUTF within 30 days of moving out of the coverage area.

Does my spouse or I need to be covered under an EUTF active employee plan at the time of retirement to be eligible to enroll in the EUTF retiree plans?

No, you do not need to be enrolled in Active plans for any amount of time or be enrolled in the EUTF Active plan at all to qualify for EUTF retiree benefits.

If I retire from the State or County and later return to work for the State or County, do I need to notify the EUTF?

Yes, if you return to work full-time for the State or County you must notify the EUTF to stop your EUTF retiree plans and you may enroll in EUTF Active plans.  If you return to work part-time or outside of the State or County, this does not apply to you.

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

Retirees must terminate their spouse’s/partner’s coverage within 30 days of the date of divorce.  Complete an EC-2 enrollment form (or EC-2H for HSTA VB members) and submit it to the EUTF within 30 days of your divorce date to terminate your spouse’s coverage.  Attach pages 1 and 2 of the divorce decree, along with the signature page.

If the EC-2/EC-2H is filed more than 60 days after the date of divorce, the retiree will be responsible for paying the employer contribution of premiums retroactive to the divorce date.

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

Complete an EC-2 enrollment form (or EC-2H for HSTA VB members) and submit it to the EUTF within 30 days of your marriage date.  Attach a copy of your marriage certificate or if it’s not available within 30 days, send it to the EUTF within 60 days of your marriage date.  You can add your spouse to your current plans – you cannot change plans.

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.

Complete an EC-2 enrollment form (or EC-2H for HSTA VB members) and submit it to the EUTF within 30 days to remove your dependent from your EUTF plans.  If the EC-2/EC-2H is filed more than 60 days after the date of divorce/partnership, the retiree shall be responsible for paying the employer contribution of premiums retroactive to the divorce date.

My child is no longer eligible (i.e., graduated from college, no longer a full-time student, etc.), but is under the age of 24. Do I need to notify the EUTF?

You must notify the EUTF and terminate your child’s medical, prescription drug, dental and vision coverage within 30 days from when they become ineligible.

Complete an EC-2 enrollment form (or EC-2H for HSTA VB members) and submit it to the EUTF within 30 days to remove your dependent from your EUTF plans.

My spouse passed away. What do I need to do?

Please see the Death checklist for more information.

What and when is open enrollment?

Open Enrollment is your opportunity to make changes to your plan enrollment.  During Open Enrollment you can:

  • Add, change or cancel plans
  • Add or remove dependents
  • Change coverage tiers such as changing from single to family, or family to two party

You will be mailed a Retiree Reference Guide which will notify you of the upcoming Open Enrollment period.  Please make sure that your address is current so that you don’t miss out on this and other EUTF communications.  Open Enrollment usually takes place in the month of October and plan and premium changes become effective Jan. 1st.

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

The following must be submitted to the EUTF in order to receive reimbursement of Medicare Part B premiums:

  1. Copy of your Medicare card indicating enrollment in Medicare Part B
  2. Medicare Part B Premium Reimbursement Request and Direct Deposit Agreement Form
  3. Social Security Administration letter 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). Generally, your reimbursement will be deposited quarterly during the first week of April, July, October and January for the prior quarter.

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;”

Who is eligible for retiree health benefits?

As a State or County retiree, you are eligible to enroll:

  • Yourself
  • Your spouse, or domestic or civil union partner
  • Your children under age 19.  Children under age 24 if unmarried and a full-time student.  Dependent children include those by birth, marriage, foster, 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

Part B

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 DPs/CUPs, and the surviving spouses or DPs/CUPs of deceased retirees and employees killed in the performance of duty;”

However, Section 87A-23 (5) allows the EUTF Board to determine which retirees and dependents may continue to participate in the EUTF retiree medical and/or prescription drug plans even though they are not enrolled in Medicare Part B.  Under this exception, the EUTF Board has allowed the following to continue to participate in EUTF retiree medical and/or prescription drug plans even if they are not enrolled in Medicare Part B:  (a) retirees that attained age 65 prior to the enactment of the law that required all eligible Medicare participants to enroll in Medicare Part B; and (b) retirees who are not citizens of the United States or lawfully admitted aliens who have not lived in the United States for at least five years and are ineligible to be enrolled in Medicare.

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

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.

Must I sign up for Medicare Part B if I am or my spouse or DP/CUP is still working and covered by another non-EUTF employer group health insurance?

In this situation, your active employee plan will be the primary plan and the EUTF retiree medical and/or prescription drug plan will be secondary. You may be advised to delay enrollment in Medicare due to your active employee plan. However, if you wish to enroll in an EUTF retiree medical and/or prescription drug plan, you must enroll in Medicare Part B.

What will happen if my spouse or DP/CUP or I fail to enroll in Medicare Part B when eligible?

EUTF Administrative Rule 5.04 (a) states;

“If an employee-beneficiary becomes eligible to enroll and fails to enroll in the federal Medicare Part B medical insurance plan, the employee-beneficiary’s enrollment in the medical and prescription drug plans offered or sponsored by the Fund and the medical and prescription drug plan coverages for dependent-beneficiaries under that enrollment shall be cancelled.”

If the spouse or DP/CUP fails to enroll, then only the spouse or DP/CUP will be cancelled from medical and prescription drug plans offered by the EUTF.  If your spouse or DP/CUP wants to continue coverage under your retiree plan, your spouse or DP/CUP is required to enroll in Medicare Part B even though he/she is still working.  If you fail to enroll, you, your spouse and any other dependents will also be canceled from the medical and prescription drug plans.  Enrollment in Medicare Part B is required to be eligible for coverage under the EUTF retiree medical and/or prescription drug plans.

I didn’t apply for Medicare when I turned 65 even though I did not have health coverage from my job or through my spouse’s or DP’s/CUP’s employer. What should I do?

If you missed the initial enrollment (a seven-month period starting three months before your 65th birthday and ending three months after your birth month), you must wait to apply for Medicare until the general enrollment period during January and March of each year. Your coverage will start the following July. You must contact the Social Security Administration to apply for Medicare by calling 1-800-772-1213 or visit their website at socialsecurity.gov. You will pay a 10 percent Medicare Part B premium penalty for each year you delayed signing up. Your EUTF Medicare Part B reimbursements will not include payment for any penalty amounts.

Will I be charged a higher Medicare B premium if I delay Medicare Part B enrollment due to being covered under an active employee plan as the subscriber or dependent?

No. If you don’t enroll in Medicare Part B when you first become eligible because you or your spouse or DP/CUP were working and had group health plan coverage through that employer, you can sign up for Medicare Part B during a special enrollment period when that coverage ends. However, you will also need to waive enrolling in EUTF retiree plans since Medicare Part B enrollment is required.

If my Medicare B premium is higher than the standard amount, will EUTF reimburse that amount?

If you are notified by Medicare that your Medicare Part B premium will have an income-related monthly adjustment amount, in other words your Medicare Part B premium is higher than the standard rate due to your higher income level, you will be reimbursed for the higher amount.  However, you MUST promptly* send the EUTF a copy of the letter from the Social Security Administration informing you of the higher Medicare premium. * (Within 2 years)

EUTF automatically re-sets your Medicare Part B reimbursement to the Medicare standard rate every January 1st.  Every year Medicare reviews your income and sets your Medicare B premium accordingly.  So, every year you must notify EUTF of your higher than standard Medicare B premium in order to receive the full reimbursement.

Where is a retiree’s spouse’s or DP/CUP’s Medicare reimbursement deposited?

Both the retiree’s Medicare reimbursement and the spouse’s or DP’s/CUP’s Medicare reimbursement must be deposited in the same account at the financial institution designated.  The retiree must be an account holder on the designated account.

Part D

Why will I receive communications and marketing materials for other non-EUTF Medicare Part D drug plans?

CMS allows all Medicare Part D plans to reach out to Medicare participants, beginning October 15 of each year.  Other Medicare Part D plans may contact you to encourage enrollment in their plan during this time, thereby leaving (i.e., disenrolling from) the EUTF’s Medicare Prescription Drug plan.

What happens if I choose to enroll in another Medicare Part D drug plan?

If you enroll in a non-EUTF Medicare Part D plan, you may be disenrolled from the EUTF Medicare Part D plan and UHC PPO medical plan or Kaiser Senior Advantage plan if applicable, because Medicare allows you to enroll in only one Medicare Part D plan.

Is the EUTF Medicare plan as good as other Medicare Part D plans?

All Medicare Part D plans must offer a minimum coverage to meet the Medicare Standard Medicare Part D plan requirements.  The EUTF Medicare Part D plan exceeds this minimum and offers participants richer, more generous, coverage than the Medicare Standard Part D plan.  The chart on page 3 provides a comparison of benefits under the EUTF Medicare Part D plan and a Standard Medicare Part D plan.  Overall, there are no existing Medicare Part D plans that we know of that provide better coverage than the EUTF’s prescription drug plan.

What must I do if I enroll in a non-EUTF Medicare Part D plan?

Please notify the EUTF in writing that you have enrolled in another non-EUTF Medicare Part D plan.

What if I have the Kaiser Permanente Senior Advantage medical plan?

All Medicare eligible members are enrolled in the Medicare Part D plan through Kaiser Senior Advantage. The EUTF enhances the Medicare Part D coverage with supplemental drug benefits that makes your current prescription drugs coverage better than the standard Medicare Part D plan.

How do SilverScript and Kaiser choose prescription drugs for their preferred drug lists (formulary)?

Pharmacy Benefit Managers such as SilverScript and health plans like Kaiser Permanente have committees of pharmacists and other health care providers who continually review drug data and studies on new and existing drugs.  Based on this data they create prescription drug formularies of those medications that have been shown to be the most effective at the most reasonable cost for each therapeutic class of medications.

CMS requires two drugs in every therapeutic category and class.  CMS thoroughly evaluates the submitted formulary design to ensure that it contains adequate access to medically necessary drugs and does not discriminate against any groups of beneficiaries.

If I enroll in a non-EUTF Medicare Part D plan, will I be reimbursed for my Medicare Part D premiums?

No.

What happens to my spouse’s/domestic or civil union partner’s EUTF coverage if my spouse or DP/CUP chooses to enroll in a non-EUTF Medicare Part D plan?

If you are enrolled in the EUTF prescription drug plan and your spouse or DP/CUP opts out of the plan, your spouse or DP/CUP will be disenrolled from the EUTF Medicare Part D plan.

I have multiple medical and prescription drug plans through different employers. How is it determined how much each plan pays and how much I pay?

Coordinating benefits between multiple plans follows standard nationally recognized rules for Coordination of Benefits. When Medicare is involved, the rules have been set by federal legislation which dictates when Medicare is the primary or secondary payer. Whether one plan is primary or secondary depends on the insured’s status and type of plan such as active employee or retiree; insured subscriber or dependent; Medicare or non-Medicare. Additionally each drug plan may have its own rules such as requiring mail order which must be satisfied for any benefits to be available from that plan. Sometimes these rules conflict and it is not possible to receive payment from both plans.

I am enrolled in the Kaiser medical plan. What will happen if I enroll in a Medicare Part D plan other than Kaiser?

If you enroll in Medicare Part D with another carrier, you will be automatically terminated from the Kaiser Senior Advantage plan.

If I’m enrolled in the EUTF Medicare Part D drug plan, am I required to get my maintenance drugs by mail order?

No.

I am a retiree enrolled in the HSTA VB plan. If I enroll in a non-EUTF Medicare Part D prescription drug plan, will I lose medical, vision, and chiropractic benefits?

Yes. These are bundled coverages and cannot be enrolled in or disenrolled from separately. However, during the next open enrollment you will be able to enroll in the EUTF (not HSTA VB) PPO medical and vision plans. However, once you disenroll from HSTA VB plans, you will not be able to re-enroll in any HSTA VB plans in the future.

Is the SilverScript preferred drug list (formulary) the same as the formulary for the CVS Caremark plan for non-Medicare retirees?

No.  There are prescription drugs that may not be included under the Medicare Part D plan but are covered under the EUTF non-Medicare retiree plan. The formulary lists for the SilverScript plans are different from the EUTF and HSTA VB non-Medicare retiree plans. However, in April 2013, EUTF added a supplemental coverage to the SilverScript plans to more closely match the formulary drug lists of the non-Medicare plans.