Enrollment Forms

EUTF Active Employee Open Enrollment

April 1 – 30, 2021

Enrollment Forms

IMPORTANT ENROLLMENT INFORMATION

About Open Enrollment
Now is the time for you to review whether the health coverage you have for yourself and your family continues to best meet your needs. During the open enrollment election period, you can:

  • Add, change, or drop a plan
  • Add or remove dependents
  • Change coverage tiers, such as changing from Self to Family, or Family to Two-Party
If you decide to keep your current plans, you don’t need to take action. You are not required to complete any forms to continue your current coverage.



MAKING CHANGES?

Complete the EC-1 or EC-1H (for those enrolled in HSTA VB plans) enrollment form and submit it to your Departmental Human Resource Office, County Personnel Office, DOE – EBU (for DOE employees), or your employer’s open enrollment designee by April 30, 2021.
Do not submit forms directly to EUTF
EC-1 Enrollment Form
EC-1H Enrollment Form