Hawaii Employer-Union Health Benefits Trust Fund

Title
2024-25 EC-1 Enrollment Form
2024-25 EC-1H Enrollment Form for HSTA VB
2024 EC-2 Enrollment Form
2024 EC-2H Enrollment Form
2025 EC-2 Enrollment Form
2025 EC-2H Enrollment Form
2024-25 Active Reference Guide
2024 Retiree Highlights Guide
2025 Retiree Highlights Guide
ACH Deduction Authorization Agreement Form
ACH Deduction Cancellation Form
Address Change Form for Employees - Counties of Hawaii and Kauai Only
Address Change - All Employers Except for Counties of Hawaii and Kauai
Address Change Form for Retirees
Administrative Rules effective 10/10/2024
Affidavit for Collection of Personal Property
Appeal Form
Chapter 87A
Death Checklist
Direct Deposit Agreement Form (Reimbursement of Medicare Part B Premiums)
Disability Certification for Dependent Children
Domestic Partnership - Declaration and Tax Affidavit
Domestic Partnership - Required Verification Documents
ERS Pension Deduction Authorization Form
ERS Pension Deduction Cancellation Form
EUTF Retiree Premium Worksheet (Retirees Hired Prior to 7/1/2001) - Effective 1/1/24 - 12/31/24
EUTF Retiree Premium Worksheet (Retirees Hired On or After 7/1/2001) - Effective 1/1/24 - 12/31/24
General Affidavit
HIPAA Authorization Form for Release of Protected Health Information
HSTA VB Retiree Premium Worksheet - Effective 1/1/24 - 12/31/24
L-1 Form - Authorized Leave of Absence Without Pay
Medicare Checklist
New Hire Enrollment Guide
Newborn Checklist
Premium Conversion Plan
Pre-Retirement Checklist

EUTF/HSTA ACTIVE