Active Employees – Qualifying Events
The following common qualifying events allow enrollment changes for Actives. To learn more about a specific event, click on the + located on the left of the event.
(Watch video on Acquisition of Coverage)
EVENT DESCRIPTION: Employee or dependent gets coverage from another plan and wishes to cancel EUTF or HSTA VB plans
WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 45 days of acquisition of coverage
DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H: Letter from carrier or employer detailing type of coverage enrolled in (i.e., medical, drug, dental, vision), effective date of coverage, and names of covered dependents within 45 days from the date of acquisition.
EFFECTIVE DATE: If coverage is gained on the 1st of the month, EUTF coverage ends last day of the month preceding. If coverage is gained on the 16th of the month, EUTF coverage ends on the 15th of the month. Otherwise, coverage ends the first day of the pay period following the acquisition of non-EUTF coverage.
CHANGES ALLOWED TO PLANS?: Employee may enroll in the supplemental health benefit plan effective the first day of the pay period following the cancellation of their EUTF coverage.
EVENT DESCRIPTION: Employee wishes to add newborn to EUTF plans
WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 180 days of event date
DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H: Birth certificate and Social Security Number must be submitted with EC-1/EC-1H and within 180 days from event date. Hospital certificate is acceptable as a temporary supporting document while awaiting birth certificate.
EFFECTIVE DATE: Employee can choose: The Event Date, the first day of the pay period following the Event Date or the first day of the 2nd pay period following the Event Date
CHANGES ALLOWED TO PLANS?: No plan changes allowed if already enrolled. May enroll in plans if not already enrolled or may add dependents to current plans if already enrolled.
EVENT DESCRIPTION: To cover eligible dependent
WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): EUTF receives the order directly from the Child Support Enforcement Agency (CSEA). No EC-1/EC-1H is required if employee is already enrolled in plans. If not enrolled, employee has 45 days from the event date to submit an EC-1/EC-1H to select plan option(s). If EC-1/EC-1H is not received within 45 days, employee and child(ren) will be added to the lowest cost PPO plan.
DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H: Birth certificate if enrolling a child for the first time in EUTF plans, and Social Security Number.
If enrolling a dependent age 19 through 23 in Dental and/or Vision coverage, student certification from an accredited school/college on school letterhead with registrar’s signature confirming full-time status or an enrollment certificate from the National Student Clearinghouse. Transcripts not accepted.
EFFECTIVE DATE: The Event Date
CHANGES ALLOWED TO PLANS?: Plan changes allowed if required by court order. May enroll in plans if not already enrolled or may add dependents to current plans if already enrolled.
WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): As soon as reasonably practical
DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H: Death certificate or copy of obituary as soon as available
EFFECTIVE DATE: Date of death or the first day of the pay period following the death for dependents.
CHANGES ALLOWED TO PLANS?: N/A
(Watch video on Demographic Changes)
EVENT DESCRIPTION: Making demographic changes such as address changes or legal name changes
WHEN ADDRESS CHANGE FORM OR EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Employees are responsible for notifying the EUTF for any demographic changes such as address changes or legal name changes as soon as possible.
DOCUMENTATION REQUIREMENTS: No additional documentation required for address changes. Proof documents are required for legal name changes such as copies of court order or letter from the Lieutenant Governor’s office.
EFFECTIVE DATE: Effective date will be as stated on Address Change form or submitted proof documents.
CHANGES ALLOWED TO PLANS OR TO ENROLL IN PLANS OR ADD DEPENDENTS?: No plan changes or enrollments allowed.
(Watch video on Divorce)
EVENT DESCRIPTION: Employee must terminate coverage for former spouse and step-children or civil union partner.
WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 45 days of divorce, however, it will be accepted and processed regardless of when form is received.
DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H: Submit pages 1 and 2 of divorce decree along with the signature page within 45 days from the date of the divorce.
EFFECTIVE DATE: If submitted within 60 days of the divorce, coverage ends the first day of the 1st pay period following the divorce. If submitted more than 60 days following the divorce, coverage ends prospectively the first day of the 1st pay period following EUTF’s receipt of the EC-1/EC-1H form.
CHANGES ALLOWED TO PLANS?: No
EVENT DESCRIPTION: Employee wishes to add child to EUTF plans
WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 45 days of guardianship date
DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H: Guardianship decree, Birth certificate, and Social Security Number submitted within 45 days from the guardianship date.
EFFECTIVE DATE: Employee can choose: The Event Date, first day of the pay period following the Event Date or first day of the 2nd pay period following the Event Date.
CHANGES ALLOWED TO PLANS?: No plan changes allowed if already enrolled. May enroll in plans if not already enrolled or may add dependents to current plans if already enrolled.
(Watch video on LWOP)
EVENT DESCRIPTION: For leave of absence without pay lasting more than 30 days, employee may waive all plans excluding life insurance or continue coverage by paying his/her share of premiums.
WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 45 days from beginning of a LWOP to waive plans. To reenroll after LWOP EC-1/EC-1H must be submitted within 45 days of return from LWOP
DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H: Employer is required to submit L-1 form
EFFECTIVE DATE: If employee cancels plans, the cancellation is effective the first day of the pay period following the LWOP.
CHANGES ALLOWED TO PLANS?: No
EVENT DESCRIPTION: Employee may terminate coverage for spouse and step-children.
WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 45 days from date of legal separation.
DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H: Court documents establishing legal separation along with the signature page within 45 days from separation date.
EFFECTIVE DATE: If submitted within 60 days, coverage ends the first day of the 1st pay period following the legal separation. If submitted more than 60 days, coverage ends prospectively the first day of the 1st pay period following EUTF’s receipt of the EC-1/EC-1H form.
CHANGES ALLOWED TO PLANS?: No
(Watch video on Loss of Coverage)
EVENT DESCRIPTION: Employee and/or dependent loses health coverage and wishes to enroll in EUTF or HSTA VB plans
WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 45 days of loss of coverage
DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H*: Letter from previous employer or carrier detailing type of coverages lost (i.e. medical, drug, dental, vision), date of loss of coverage, names of any covered dependents. Birth certificate, student certification (if applicable), and Social Security Number if adding any dependent children, marriage certificate if adding spouse within 45 days of loss of coverage.
EFFECTIVE DATE: The first day following the day non-EUTF coverage was lost.
CHANGES ALLOWED TO PLANS?: No plan changes allowed if already enrolled. May enroll in plans if not already enrolled or may add dependents to current plans if already enrolled. If proof document notification date is outside of the initial 45-day enrollment period, the employee will be given 45-days from the notification date to submit EC-1/EC-1H form and required documents. Those losing coverage from a Medicaid plan have 60 days from event date to submit EC-1/EC-1H form and required documents. The effective date of coverage will be the day following the day non-EUTF coverage was lost.
EVENT DESCRIPTION: Employee wishes to enroll new spouse in EUTF plans
WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 45 days from date of marriage
DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H: Marriage certificate and Social Security Number. Birth certificate, student certification (a letter from the school registrar’s office or certificate from the National Student Clearinghouse, if applicable) and Social Security Number if adding any dependent children within 45 days from the marriage date.
EFFECTIVE DATE: Employee can choose: The Event Date, first day of the pay period following the Event Date or first day of the 2nd pay period following the Event Date.
CHANGES ALLOWED TO PLANS?: No plan changes allowed if already enrolled. May enroll in plans if not already enrolled or may add dependents to current plans if already enrolled.
EVENT DESCRIPTION: Employee wishes to enroll new civil union partner in EUTF plans
WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 45 days of civil union
DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H: Civil Union certification (on-line proof accepted), Affidavit of Dependency and Social Security Number submitted within 45 days from the civil union date.
If adding Dependents:
- Birth certificate and Social Security Number
- If enrolling a dependent age 19 through 23 in Dental and/or Vision coverage, student certification from an accredited school/college on school letterhead with registrar’s signature confirming full-time status or an enrollment certificate from the National Student Clearinghouse. Transcripts not accepted.
EFFECTIVE DATE: Employee can choose: The Event Date, first day of the pay period following the Event Date or first day of the 2nd pay period following the Event Date.
CHANGES ALLOWED TO PLANS?: No plan changes allowed if already enrolled. May enroll in plans if not already enrolled or may add dependents to current plans if already enrolled.
(Watch video on Domestic Partnership Enrollment)
EVENT DESCRIPTION: Employee wishes to enroll new domestic partner in EUTF plans
WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 45 days of date of notarized signature (event date is considered date of notarization)
DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H: Notarized Declaration of Domestic Partnership, Affidavit of Dependency & Acknowledgement and two sets of documents showing proof of shared residency submitted within 45 days from the domestic partnership notary date. Documents available at eutf.hawaii.gov. Birth certificate, student certification (a letter from the school registrar’s office or certificate from the National Student Clearinghouse, if applicable) and Social Security Number if adding any dependent children within 45 days from the domestic partnership date.
EFFECTIVE DATE: Employee can choose: The Event Date (notary date), first day of the pay period following the Event Date or first day of the 2nd pay period following the Event Date.
CHANGES ALLOWED TO PLANS?: No plan changes allowed if already enrolled. May enroll in plans if not already enrolled or may add dependents to current plans if already enrolled.
EVENT DESCRIPTION: New employee wishes to enroll in EUTF plans
WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 45 days from new hire/newly eligible start date
DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H:
- Marriage Certificate, Civil Union Certificate or Domestic Partnership Forms, if enrolling a spouse/DP;
- Social Security Number;
- Birth certificate for dependent children;
- Student certification from an accredited school on school letterhead with registrar’s signature confirming full-time status or certificate from the National Student Clearinghouse, within 45 days from date of hire if enrolling a dependent(s) ages 19 through 23, in dental and/or vision.
EFFECTIVE DATE: Employee can choose: The Event Date, first day of the pay period following the Event Date or first day of the 2nd pay period following the Event Date.
CHANGES ALLOWED TO PLANS?: N/A
EVENT DESCRIPTION: Employee wishes to add unmarried dependent child in dental or vision plan because child became a full-time student and is between the ages of 19 through 23
WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 45 days from school start date
DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H: Student certification from an accredited school on school letterhead with registrar’s signature confirming full-time status or certificate from the National Student Clearinghouse if enrolling a dependent(s) ages 19 through 23, in dental and/or vision. Transcripts are not accepted.
EFFECTIVE DATE: Employee can choose: The Event Date, first day of the pay period following the Event Date or first day of the 2nd pay period following the Event Date.
CHANGES ALLOWED TO PLANS?: No plan changes allowed if already enrolled. May enroll in dental and/or vision plans if not already enrolled.
EVENT DESCRIPTION: Employee must terminate domestic partner and domestic partner’s dependents
WHEN EC-1/EC-1H MUST BE SUBMITTED TO EMPLOYER (Personnel Office): Within 45 days of termination of partnership, however, it will be accepted and processed regardless of when form is received.
DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-1/EC-1H: Declaration of Termination of Domestic Partnership
EFFECTIVE DATE: Coverage ends the first day of the 1st pay period following the date of termination of the domestic partnership.
CHANGES ALLOWED TO PLANS?: No