Hawaii Employer-Union Health Benefits Trust Fund

EVENT DESCRIPTION: Retiree or dependent gets coverage from another plan and wishes to cancel EUTF or HSTA VB plans

WHEN EC-2/EC-2H MUST BE SUBMITTED TO EUTF: Within 45 days from effective date of acquiring coverage elsewhere

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-2/EC-2H: Letter from carrier or employer detailing type of coverages enrolled in (i.e., medical, drug, dental, vision), effective date of coverage, and names of covered insured and/or dependents

EFFECTIVE DATE: End of pay period in which retiree acquires coverage from a non-EUTF plan, except when the retiree acquires 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

CAN I CHANGE PLANS?: N/A

EVENT DESCRIPTION: Retiree wishes to add newborn to plans

WHEN EC-2/EC-2H MUST BE SUBMITTED TO EUTF: Within 180 days from event date

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-2/EC-2H: Birth certificate and Social Security Number must be submitted with EC-2/EC-2H and within 180 days from event date. Hospital certificate is acceptable as a temporary supporting document while awaiting birth certificate.

EFFECTIVE DATE: Retiree can choose: birth date, beginning of the next pay period after birth date, or beginning of 2nd pay period after birth date

CAN I CHANGE PLANS?: No plan changes allowed if already enrolled. May enroll in plans if not already enrolled or may add dependents if already enrolled.

WHEN EC-2/EC-2H MUST BE SUBMITTED TO EUTF: N/A

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-2/EC-2H: Proof of compliance documentation provided to EUTF

EFFECTIVE DATE: The date set forth in a notice to the retiree of his/her failure to comply with the Rules

CAN I CHANGE PLANS?: N/A

WHEN EC-2/EC-2H MUST BE SUBMITTED TO EUTF: As soon as reasonably practical

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-2/EC-2H: Death certificate or copy of obituary as soon as available

EFFECTIVE DATE: Date of death or last day of pay period in which death occurs for dependents

CAN I CHANGE 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-2/EC-2H MUST BE SUBMITTED TO THE EUTF: Retirees are responsible for notifying the EUTF or 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 the Retiree 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: Retiree must terminate spouse or civil union partner’s coverage

WHEN EC-2/EC-2H MUST BE SUBMITTED TO EUTF: Within 45 days of date of divorce. If EC-2/EC-2H is filed more than 45 days after date of divorce, retiree is responsible for paying the employer contribution premiums retroactive to the divorce date.

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-2/EC-2H: Pages 1 and 2 of divorce decree, along with signature page.

EFFECTIVE DATE: First day of the first pay period following the divorce

CAN I CHANGE PLANS?: No

EVENT DESCRIPTION: Retirees and their dependents who are eligible to enroll in Medicare Part B must enroll

WHEN EC-2/EC-2H MUST BE SUBMITTED TO EUTF: N/A

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-2/EC-2H: N/A

EFFECTIVE DATE: Cancellation in the medical and prescription drug plan is effective the date the retiree or dependent first became eligible to enroll in Medicare Part B

CAN I CHANGE PLANS?: N/A

EVENT DESCRIPTION: Retiree owes a shortage, but does not pay shortage by due date – enrollment will be cancelled

WHEN EC-2/EC-2H MUST BE SUBMITTED TO EUTF: N/A

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-2/EC-2H: None

EFFECTIVE DATE: If enrollment is cancelled, retiree may only re-enroll during the next open enrollment period

CAN I CHANGE PLANS?: No

EVENT DESCRIPTION: Retiree enrolled in Kaiser and moves to an area where Kaiser is not available

WHEN EC-2/EC-2H MUST BE SUBMITTED TO EUTF: Within 45 days from the date of relocation

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-2/EC-2H: None

EFFECTIVE DATE: The date of the retiree’s relocation.

CAN I CHANGE PLANS?: Yes

EVENT DESCRIPTION: Dependent child is no longer a full-time student and is age 19 through 23

WHEN EC-2/EC-2H MUST BE SUBMITTED TO EUTF: As soon as the dependent child is no longer enrolled as a full-time student

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-2/EC-2H: None

EFFECTIVE DATE: First day of the pay period following the date the child was no longer enrolled as a full-time student

CAN I CHANGE PLANS?: No

EVENT DESCRIPTION: Retiree must terminate spouse’s or civil union partner’s EUTF or HSTA VB coverage

WHEN EC-2/EC-2H MUST BE SUBMITTED TO EUTF: Within 45 days of date of legal separation. If EC-2/EC-2H is filed more than 45 days after date of legal separation, retiree is responsible for paying the employer contribution premiums retroactive to the legal separation date.

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-2/EC-2H: Court document establishing legal separation, including any pages regarding health benefits to children

EFFECTIVE DATE: First day of the pay period following the legal separation

CAN I CHANGE PLANS?: No

EVENT DESCRIPTION: Retiree and/or dependent lost coverage from a non-EUTF plan, wishes to enroll in EUTF or HSTA VB plans, and for dependents the retiree is currently enrolled in an EUTF or HSTA VB plan

WHEN EC-2/EC-2H MUST BE SUBMITTED TO EUTF: Within 45 days from loss of other coverage

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-2/EC-2H: Loss of coverage letter from previous employer/carrier detailing type of coverages lost (i.e., medical, drug, dental, vision), date of loss of coverage, and names of any covered dependents.

Copy of dependent’s Medicare card showing Part B and letter from Social Security for retiree’s spouse or partner, if eligible to enroll. DDA form if retiree is not Medicare eligible yet.

If adding Dependents:

• Spouse or Partner:
  • Marriage, Civil Union certificate or Domestic Partnership documents and Social Security Number, if not previously submitted to the EUTF
• Dependent Child:
  • Birth certificate and Social Security Number
  • If enrolling a dependent age 19 through 23, 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: Day following loss of coverage from other plan

CAN I CHANGE PLANS?: No plan changes allowed if already enrolled. May enroll in plans if not already enrolled or may add dependents if already enrolled.

WHEN EC-2/EC-2H MUST BE SUBMITTED TO EUTF: Within 45 days from date of marriage

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-2/EC-2H: Marriage Certificate

Copy of spouse’s Medicare card showing Part B and letter from Social Security, if eligible to enroll. DDA form if retiree is not Medicare eligible yet.

If adding Dependents:

• Birth certificate and Social Security Number
• If enrolling a dependent age 19 through 23, 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 date of marriage, 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

CAN I CHANGE PLANS?: No plan changes allowed if already enrolled. May enroll in plans if not already enrolled or may add dependents if already enrolled.

EVENT DESCRIPTION: Retiree wishes to enroll new civil union partner in EUTF or HSTA VB plans

WHEN EC-2/EC-2H MUST BE SUBMITTED TO EUTF: Within 45 days from date of civil union

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-2/EC-2H: Civil Union certification (on-line proof accepted), Affidavit of Dependency.

Copy of Partner’s Medicare card showing Part B and letter from Social Security, if eligible to enroll. DDA form if retiree is not Medicare eligible yet.

If adding Dependents:

• Birth certificate and Social Security Number
• If enrolling a dependent age 19 through 23, 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 date of the civil union, or the first day of the first pay period after the date of the Civil Union, or the first day of the 2nd pay period after the date of the Civil Union

CAN I CHANGE PLANS?: No plan changes allowed if already enrolled. May enroll in plans if not already enrolled or may add dependents if already enrolled.

(Watch video on Domestic Partnership Enrollment)

EVENT DESCRIPTION: Retiree wishes to enroll new domestic partner in EUTF or HSTA VB plans

WHEN EC-2/EC-2H MUST BE SUBMITTED TO EUTF: Within 45 days from date of notarized signature (event date is considered date of notarization)

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-2/EC-2H: Notarized Declaration of Domestic Partnership and Affidavit of Dependency (notarized if IRS qualified). Forms available on the EUTF website.

Copy of Partner’s Medicare card showing Part B and letter from Social Security, if eligible to enroll. DDA form if retiree is not Medicare eligible yet.

If adding Dependents:

• Birth certificate and Social Security Number
• If enrolling a dependent age 19 through 23, 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 date the notary signs the Declaration of Domestic Partnership, the first day of the first pay period after the notary signs, or the first day of the 2nd pay period after the notary signs

CAN I CHANGE PLANS?: No plan changes allowed if already enrolled. May enroll in plans if not already enrolled or may add dependents if already enrolled.

EVENT DESCRIPTION: Retiree wishes to enroll child because child became full-time student and is age 19 through 23

WHEN EC-2/EC-2H MUST BE SUBMITTED TO EUTF: Within 45 days from school start date

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-2/EC-2H:

• Birth certificate
• Social Security Number
• 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: Date child becomes full-time student, the first day of the first pay period after becoming a full-time student, or the first day of the 2nd pay period after becoming a full-time student

CAN I CHANGE PLANS?: No plan changes allowed if already enrolled. May enroll in plans if not already enrolled or may add dependents if already enrolled.

EVENT DESCRIPTION: Surviving spouse or domestic partner will be cancelled from EUTF’s or HSTA VB’s plans

WHEN EC-2/EC-2H MUST BE SUBMITTED TO EUTF: Within 45 days from the remarriage or the new domestic partnership

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-2/EC-2H: None

EFFECTIVE DATE: The first day of the pay period following the remarriage or new partnership

CAN I CHANGE PLANS?: N/A

EVENT DESCRIPTION: Retiree must terminate domestic partner from EUTF or HSTA VB plans

WHEN EC-2/EC-2H MUST BE SUBMITTED TO EUTF: Within 45 days of termination of domestic partnership. If EC-2/EC-2H is filed more than 45 days after date of termination of domestic partnership, retiree is responsible for paying the employer contribution premiums retroactive to the date of termination of domestic partnership.

DOCUMENTATION REQUIRED TO BE ATTACHED TO EC-2/EC-2H: Declaration of Termination of Domestic Partnership. Forms are available on the EUTF website.

EFFECTIVE DATE: First day of the pay period following the date of the termination of the domestic partnership

CAN I CHANGE PLANS?: No