Hawaii Employer-Union Health Benefits Trust Fund

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 National Student Clearinghouse

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.

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.

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, visit COBRA General 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.  Watch a short overview video on COBRA.

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 or placement for adoption.  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.

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 and social security number are required for all newly added dependent children.  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.

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.

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 with a copy of your marriage certificate within 45 days of your marriage date. You can add your spouse to your current plans – you cannot change plans.  For DOE employees, you must submit your form to:

DOE-EBU
PO Box 2360
Honolulu, HI 96804

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 45 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.

Employees must immediately notify EUTF of their divorce. Employees need to complete an EC-1 enrollment form (or EC-1H for HSTA VB members) and submit it to their departmental human resources office or enrollment designee within 45 days of your divorce date to terminate their ex-spouse’s coverage.  Employees must also attach pages 1 and 2 of the divorce decree along with the signature page. For DOE employees, you must submit your form to:

DOE-EBU
PO Box 2360
Honolulu, HI 96804

If received timely, the former spouse’s coverage will end the first day of the pay period following the divorce.  If the EC-1/EC-1H is filed more than 60 days after the date of divorce, the ex-spouse will be removed prospectively based on the date the EC-1/EC-1H is received by the employer and the employee will be responsible for the employer portion of premiums retroactive to the divorce date.

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 45 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.

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 45 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 45 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, visit premium payment options.

If you do not submit an EC-1/EC-1H enrolment form within 45 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.

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 45 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 45 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.

You must notify the EUTF and terminate your child’s dental and vision coverage within 45 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 45 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.

Counties of Hawaii and Kauai Only – Complete an Employee Address Change Form and submit it to your departmental human resources office or enrollment designee as soon as possible.

All Employers except Counties of Hawaii and Kauai – Addresses must be updated through your personnel office. Please contact your personnel office directly to update your address. No action will be taken on address changes submitted directly to the EUTF.

State Executive Branch, Legislative Branch, and HHSC – Addresses must be updated through the Hawaii Information Portal (HIP). No action will be taken on address changes submitted directly to the EUTF.

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.

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.  View and download the Reference Guide.

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, National Benefit Services.  For County employees, contact your personnel office for more information.

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 County employees, contact your personnel office for more information.

Sign-up to attend a pre-retirement health benefits workshop, or view the Pre-retirement Checklist and Medicare Checklist.

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.

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.