Hawaii Employer-Union Health Benefits Trust Fund

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.

In cases where HSTA VB members have a spouse/partner covered under active or retiree EUTF plans, members cannot enroll in the same health plan coverages under both EUTF and HSTA VB plans simultaneously (e.g. EUTF medical and HSTA VB medical, or EUTF dental and HSTA VB dental).

ID Cards

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:

1. You gain a new dependent through marriage and want to enroll your spouse and/or newly eligible dependent children, you must request enrollment within 45 days after the marriage. A copy of your marriage certificate, birth certificates for all eligible dependent children and full-time student certification when applicable are required.
2. You gain a new dependent through birth, adoption or placement of adoption, and need to enroll a newborn or newly adopted child. You must request enrollment within 45 days after the adoption or placement for adoption, and within 180 days after the birth of a newborn. In order to add a newly adopted/placed for adoption child to your coverage, you must provide appropriate documents verifying the adoption in order to have the application accepted. To enroll a newborn, you must attach a copy of the birth certificate with your EC-2H form. A Social Security Number is required within 60 days of submitting your enrollment form to the EUTF.
3. If you previously declined enrollment for yourself or your dependents (including your spouse) because of other health insurance or group health plan coverage, you may be able to enroll yourself and your dependents in this plan if your enrollment in non-EUTF plans changes, or you or your dependents move out of the plan’s service area, resulting in a loss of health coverage. You must request enrollment within 45 days after your or your dependent’s other coverage ends. Submit a copy of the Loss of Coverage letter from the previous employer/plan detailing the type of coverage lost (e.g. medical, dental, prescription drug, vision), the effective date of the loss of coverage, the name(s) of dependent(s) who lost the coverage, and birth certificates for any dependent children being added to the plan.
4. You and your eligible dependents may also enroll in this plan if you (or your dependents):
   • have coverage through Medicaid or a State Children’s Health Insurance Program (CHIP) and you (or your dependents) lose eligibility for that coverage. However, you must request enrollment within 60 days after the Medicaid or CHIP coverage ends.
   • become eligible for a premium assistance program through Medicaid or CHIP. However, you must request enrollment within 60 days after you (or your dependents) are determined to be or are notified that you are eligible for such assistance.

   You must provide the EUTF a copy of a letter from Medicaid or CHIP detailing the type of coverage acquired (e.g. medical, dental, prescription drug, vision), the effective date of coverage, the name(s) of covered dependent(s) and the date of the letter.

To request special enrollment or obtain more information, contact the EUTF office at (808) 586-7390 or toll-free at 1-800-295-0089.

End of Coverage

Common situations resulting in the loss of coverage are:

1. You do not make required premium payments (if applicable).
2. You die, subject to exceptions for your surviving spouse or DP/CUP and unmarried children under age 19.
3. You fail to comply with the EUTF Administrative Rules.
4. You file fraudulent claims.
5. Your surviving spouse or DP/CUP remarries.

1. Your dependent is no longer eligible for coverage such as due to a divorce, legal separation or overage children.
2. Your dependent enters the uniformed services.
3. 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:

1. The application seeks to enroll a person who is not eligible to enroll in the benefit plan for which enrollment is requested;
2. The application is not filed within the time limitations prescribed by the rules.
3. The application contains an intentional misstatement or misrepresentation of a material fact or contains other information of a fraudulent nature;
4. The employee-beneficiary owes past due contributions or other amounts to the EUTF;
5. Acceptance of the application would violate applicable federal or state law or any other provision of the rules; or
6. 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:

• EUTF Medicare Part B Reimbursement
• EUTF Medicare Part D Plans (Prescription Drug)