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State of Hawaii

Hawaii Employer-Union Health Benefits Trust Fund

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    • EUTF Active Forms
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    • HSTA VB Retiree Forms
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Retirees Resource > EUTF Retiree Forms

EUTF Retiree Forms

  • EC-2 Retiree Print and Fill Form “Effective January 1, 2012″  (PDF)   12/30/11

  • 2013 Retiree 0%, 50%, 75% Worksheet – Effective January 1, 2013  (PDF)   12/14/12

  • Direct Deposit Authorization Print and Fill Form  (PDF)   Effective 07/01/07

  • Authorization for Release of Protected Health Information Print and Fill Form  (PDF)

  • Disability Certification for Dependent Children  (PDF)

  • Civil Union Forms   09/14/12

  • Domestic Partner Forms  

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