HSTA VB Retiree – Enrollment Overview
To enroll, you must complete a EUTF Enrollment Form for Retirees EC-2H. The plan year for retiree plans begins January 1 and ends December 31 of each year.
Retirees who are already enrolled in HSTA VB plans who change to the EUTF plans may NOT change back to HSTA VB plans in the future. Additionally, retirees enrolled in the HSTA VB plans may not enroll in some HSTA VB plans and some EUTF plans – they must be enrolled in all HSTA VB plans or all EUTF plans.
After you enroll for the first time, you will receive identification cards from the plans as follows:
- HMSA and HDS will issue two identical ID cards showing the name of the subscriber.
- Kaiser, UHC, CVS Caremark, and SilverScript issue an ID card for each enrolled member of a family upon initial enrollment.
- ChiroPlan Hawaii under Royal State National, USAble and VSP –ID cards are not required to obtain services.
Dual Family Enrollment (Two EUTF Retiree Two-Party or Family Enrollments) Is Not Allowed
If both you and your spouse or DP/CUP are eligible to enroll in either EUTF retiree or EUTF active employee plans, only one of you may enroll in an EUTF 2-Party or Family plan. If no other dependents are involved, both may enroll in EUTF Self plans. Dual enrollment in EUTF 2-party or family plans is not allowed under EUTF Administrative Rule 4.03. The dual enrollment rule does not apply if your other coverage is not provided by the EUTF such as if your spouse or DP/CUP has coverage outside of the EUTF through a non-EUTF employer.
Special Enrollment Period Due to a Qualifying Event
You are eligible to make changes other than during the Open Enrollment period for the following reasons:
- You marry and want to enroll your spouse and /or newly eligible dependent children. A copy of your marriage certificate is required.
- You need to enroll a newborn or newly adopted child. In order to add a newly adopted child to your coverage, you must provide appropriate documents verifying the adoption in order to have the application accepted. To enroll a newborn you do not need to attach a copy of the birth certificate or submit the social security number to your EC-2H. A copy of the birth certificate is required only if the child has a different last name from the retiree. A Social Security Number is required within 60 days from the date of the EUTF Confirmation Notice.
- You have a change in family status involving the loss of eligibility of a family member (e.g., separation, divorce, death, child marries, no longer lives with you, loses student status or turns age 19 or 24 if a student).
- Your spouse’s, or DP’s/CUP’s, or eligible dependent’s employment status changes resulting in a loss of health coverage. A copy of the Loss of Coverage Letter from the previous employer/carrier 11 detailing type of coverage lost (i.e. medical, dental, prescription drug, etc.), date of Loss of Coverage, name(s) of covered dependent(s).
- You move out of your plan’s service area. To change your coverage, you must complete Form EC-2H and submit it to the EUTF within 30 days of the date of the event. Except in the case of newborns where you have 60 days to submit your EC-2H Form. Generally, deletion of dependents is effective on the first day of the first pay period following the occurrence of the event. Dependent children are automatically terminated as of the end of the pay period they attain age 19 or 24 if they are full-time students and do not require the completion of an application to delete coverage. If events are filed within 30 days of qualifying event date, some events allow for a selection of the Coverage and Premium Contribution Start Dates. These events include: Adoption, Birth, Guardianship, New Eligible Student, Marriage, New Domestic Partner, New Civil Union Partner, Newly Eligible Student and Placement for Adoption. However, if you enroll in the new Medicare Advantage plan through UHC, coverage starts the first of the month following the signature date on your EC-2H.
End of Coverage
Common situations resulting in the loss of coverage are:
- You do not make required premium payments (if applicable).
- You die, subject to exceptions for your surviving spouse or DP/CUP and unmarried children under age 19.
- You fail to comply with the EUTF Administrative Rules.
- You file fraudulent claims.
- Your surviving spouse or DP/CUP remarries.
Your dependent is no longer eligible for coverage such as due to a divorce, legal separation or overage children.
Your dependent enters the uniformed services.
Your surviving spouse or DP/CUP partner remarries, or enters into a new partnership.
Effective Date of Termination
In general, when an event causes you or your dependent’s coverage to terminate, such termination will be effective on the first day of the first pay period following the occurrence of the event, e.g., divorce, end of domestic or civil union partnership, death, surviving spouse remarries, or child ceases to be eligible for coverage. There may be certain instances in which the effective date of termination is different. You may obtain additional information by referring to the EUTF administrative rules.
Rejection of Enrollment
Enrollment in EUTF benefit plans is contingent on meeting all eligibility criteria detailed in the EUTF administrative rules. Any enrollment application may be rejected if it is incomplete or does not contain all information required.
An enrollment application shall be rejected if:
- The application seeks to enroll a person who is not eligible to enroll in the benefit plan for which enrollment is requested;
- The application is not filed within the time limitations prescribed by the rules.
- The application contains an intentional misstatement or misrepresentation of a material fact or contains other information of a fraudulent nature;
- The employee-beneficiary owes past due contributions or other amounts to the EUTF;
- Acceptance of the application would violate applicable federal or state law or any other provision of the rules; or
- Centers for Medicare and Medicaid Services (CMS) deems you not eligible.
Retirees will be notified of the rejection of any enrollment application.
Medicare and Enrollment in EUTF Plans
Medicare eligible retirees must enroll in Medicare Part B to be covered or continue to be covered under an EUTF retiree medical and/or prescription drug plan. A spouse / domestic partner/ civil union partner who is enrolled as a dependent under an EUTF retiree medical and/or prescription drug plan must also enroll in Medicare Part B when they become eligible for Medicare.
Medicare Part B Premium Reimbursement
Retirees and their spouses or DPs/CUPs who are enrolled in Medicare Part B and are paying Medicare Part B premiums are eligible for Medicare Part B premium reimbursements. This does not apply to active employees eligible for Medicare who are covered by EUTF active employee plans. However, if you are an active employee, enrolled in Medicare Part B and covered by an EUTF retiree plan through your spouse or DP/CUP, your spouse or DP/CUP is entitled to Medicare Part B reimbursement for you.
For additional information on Medicare and EUTF plans, please refer to the sections for Medicare eligible participants: