Medicare – FAQs

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.

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

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.

Part B

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.

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.

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.

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.

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.

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.

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.

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.

Part D

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.

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.

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 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.

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.

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.

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

No.

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.

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.

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.

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 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.

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.