How to Fill Out and Submit the EC-1: Hawaii EUTF Enrollment Form

The Hawaii EUTF EC-1 form is the enrollment document that state and county employees use to sign up for medical, dental, vision, and life insurance through the Employer-Union Health Benefits Trust Fund. You use it when you’re newly hired, during the annual open enrollment window, and whenever a qualifying life event lets you change coverage mid-year. The form itself is short, but using the wrong version or missing a document is what trips most people up.

Pick the Right Version Before You Start

The EUTF publishes two main EC-1 forms each plan year, split by bargaining unit. The “Ratified” form covers Bargaining Units 00 through 10, 12, and 13. The “Non-Ratified” form covers Bargaining Units 11, 14, and 15.¹ HSTA Voluntary Benefits members use a separate EC-1H.

Check a recent pay stub for your bargaining unit number, or ask your departmental HR office, before you download. Submitting the wrong version will delay processing. Both are available on the EUTF website and through personnel offices.

Know Your Filing Window

You can only submit an EC-1 inside one of three windows: a new-hire window, open enrollment, or a qualifying life event window. Miss the window and you wait.

New Hires

Newly hired or newly eligible employees have 45 days from the start date to submit the EC-1.² Miss it and you cannot enroll until the next open enrollment, with no EUTF coverage in between.

Open Enrollment

Open enrollment for the 2026–27 plan year runs May 1 through May 29, 2026.³ During open enrollment you can switch plans, add or drop dependents, or enroll if you previously waived. Changes take effect July 1.

Qualifying Life Events

Outside open enrollment, you need a qualifying event. Deadlines are counted from the event date:

Marriage or civil union: 45 days to add the spouse or partner.
Birth of a child: 180 days to add the newborn.
Adoption or placement for adoption: 45 days.
Guardianship: 45 days to add a child placed under your legal guardianship.
Domestic partnership: 45 days from the notarized signature date.
Loss of other coverage: 45 days after you or a dependent loses it.
Return from leave without pay: 45 days after returning, if you waived plans during the leave.

For removing coverage, the windows are: divorce, 45 days; legal separation, 45 days; a dependent’s death, as soon as reasonably practical; a dependent gaining other coverage, 90 days.² After a divorce you are required to remove the former spouse and any stepchildren from your plans.

Filling Out the Form

The EC-1 has four sections. Have your personal information, dependents’ details, and plan picks in front of you before you start.

Section 1: Employee Data

Enter your full legal name, home and work phone numbers, email, and both mailing and residence addresses if they differ.⁴ First-time enrollees must provide their Social Security number and the Social Security numbers of any dependents being added.⁵

Check the reason-for-filing box that matches your situation. “New Hire/Newly Eligible” takes a hire date. “Open Enrollment” only applies during the annual window. “Mid-Year Qualifying Event” requires the date the event occurred. A termination filing takes your last day of work.

If you are married, in a civil union, or in a domestic partnership, check the box and enter the date, then fill in your spouse’s or partner’s name, date of birth, and Social Security number.

Section 2: Coverage and Contribution Start Date

New hires and newly eligible employees choose from three start dates: the date of hire, the first day of the first pay period after hire, or the first day of the second pay period after hire.⁶ Leave it blank and the form defaults to the first option. This choice also controls when premium deductions begin, so pick the date that matches when you want both coverage and deductions to start.

Section 3: Plan Selection

Mark one medical/prescription drug plan, one dental plan, and one vision plan. Prescription drug coverage comes with your medical plan rather than as a separate election.⁷ If you don’t want coverage in a category, mark “Cancel/Waive” for that line.

Life insurance through the EUTF covers the employee only. You cannot extend it to dependents on this form.

Section 4: Dependent Information

For each dependent, list the full name, date of birth, Social Security number, and relationship code. The form uses: SP for spouse, CH for child, SC for stepchild, DP for domestic partner, DPCH for domestic partner’s child, GC for grandchild, CU for civil union partner, CUCH for civil union partner’s child, and DC for disabled child.⁴ Pick the specific plans each dependent should be enrolled in. Dependents don’t have to be on the same plans as you.

Dependent Eligibility

Children are eligible until they turn 26, regardless of student status, financial dependency, or where they live. This covers children by birth, marriage, adoption, or placement for adoption. Children under legal guardianship lose eligibility at 18.⁸

A disabled child can stay on your plan past 26 if the impairment existed before age 19 and the child is incapable of self-support.⁸ Expect the EUTF to request medical documentation when you add a disabled adult child.

Documents You Need to Attach

The EUTF will not process the enrollment of a dependent without proof of the relationship. Missing documents are the single most common reason an EC-1 stalls.

Spouse: marriage certificate.⁹
Civil union partner: certificate issued by the Hawaii Department of Health.¹⁰
Domestic partner: a Declaration of Domestic Partnership on the form prescribed by the EUTF Board of Trustees, an Affidavit of Dependency for Tax Purposes, and two sets of documents proving shared residency.¹⁰
Child by birth: birth certificate and Social Security number. For newborns, you can submit the Social Security number once it arrives from the Social Security Administration; it doesn’t have to be on the initial form.¹¹
Adopted child: legal adoption decree or placement documentation.
Child under guardianship: court-issued guardianship order.

The EUTF may ask for additional documentation beyond this list.¹⁰ Gather everything before you submit.

The Premium Conversion Plan Checkbox

State employees will see a Premium Conversion Plan (PCP) line on the EC-1. Enrolling in PCP means your health premiums come out of your paycheck before federal, state, and FICA taxes are calculated, which lowers your taxable income. It operates under Section 125 of the Internal Revenue Code.

If you leave the PCP field blank on a new enrollment, the default is “Not Enrolled” and your premiums come out of after-tax dollars. Employees already in PCP who submit a new EC-1 during open enrollment stay enrolled automatically unless they mark cancel.⁷ The tradeoff: under federal cafeteria plan rules, pre-tax elections are generally locked in for the plan year, and you typically cannot change your PCP election mid-year without a qualifying event.

If You’re Waiving Coverage

If you already have coverage from another source, such as a spouse’s employer, mark “Cancel/Waive” in the plan selection section. Once you waive, you cannot re-enroll until the next open enrollment unless you have a qualifying event like losing that other coverage.⁷ To be eligible for the Royal State Supplemental plan specifically, you must carry medical coverage from another source outside your EUTF employer.

Where to Submit

Turn in your completed EC-1 and documents to your department’s human resources office or designated enrollment coordinator, not directly to the EUTF. HR verifies your employment status, signs the employer section, and forwards the package to the EUTF.⁷

Department of Education staff submit instead to the DOE Employee Benefits Unit at DOE-EBU, PO Box 2360, Honolulu, HI 96804. The address is also printed in the upper-right corner of the DOE version of the form.⁷

For many qualifying events, the EUTF now also directs employees to complete enrollment through the EUTF Member self-service portal, with the paper EC-1 as a backup or supplement.² Ask your HR office whether your department uses the portal, the paper form, or both.

After You Submit

Once HR forwards the EC-1, the EUTF processes the enrollment and notifies your carriers. ID cards from each carrier should arrive shortly after enrollment is finalized.¹² Check your next few pay stubs to confirm the premium deductions match the plans you picked. Rates vary by bargaining unit, plan, and coverage tier; the EUTF posts rate sheets for each plan year on the “Premiums & Contributions” page for your employee group.

1
Hawaii Employer-Union Health Benefits Trust Fund. All EUTF Forms
2
Hawaii Employer-Union Health Benefits Trust Fund. EUTF Active Employee Qualifying Events
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Hawaii Employer-Union Health Benefits Trust Fund. Open Enrollment
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Hawaii Employer-Union Health Benefits Trust Fund. Instructions for Completing Form EC-1
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Hawaii Employer-Union Health Benefits Trust Fund. Instructions for Completing Form EC-1
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Hawaii Employer-Union Health Benefits Trust Fund. HSTA VB Active – Enrollment Overview
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Hawaii Employer-Union Health Benefits Trust Fund. EC-1 Health Benefits Enrollment Form
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Hawaii Employer-Union Health Benefits Trust Fund. EUTF Active – FAQs
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Hawaii Employer-Union Health Benefits Trust Fund. EUTF Active – Eligibility
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Hawaii Employer-Union Health Benefits Trust Fund. Domestic Partner or Civil Union Enrollment
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Hawaii Employer-Union Health Benefits Trust Fund. I’m Having a Baby. What Do I Need to Do to Enroll My Baby in My Health Plans?
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Hawaii Employer-Union Health Benefits Trust Fund. EUTF Active – Enrollment Overview