TARGET GRAMMAR: NATURAL — How to Complete and Submit the EC-2 Form

The EC-2 form is what retired Hawaii state and county employees use to enroll in or change their health benefits through the Employer-Union Health Benefits Trust Fund (EUTF), covering medical, prescription drug, dental, vision, and life insurance for the retiree and eligible dependents.¹ Download the current version from the EUTF forms page or request a copy from the EUTF office in Honolulu.² If you have not yet retired, the EC-2 is not your form; active employees file the EC-1 instead.³

When You Can File

Three windows accept an EC-2: your retirement, the annual Open Enrollment period, and the window following a qualifying life event. For 2026, Open Enrollment runs May 1 through May 29.⁴ During that month you can switch plans, add or drop dependents, or cancel coverage without needing any special reason.

Outside Open Enrollment, you need a qualifying event, and each event has its own deadline measured from the date it occurred:⁵

45 days: marriage, civil union, domestic partnership, adoption, loss of other coverage, geographic relocation, divorce, legal separation, or termination of a domestic partnership.
60 days: retirement or enrollment in Medicare Part B.
90 days: disenrollment because you enrolled in other coverage.
180 days: birth of a child.

Miss the deadline and you cannot make the change until the next Open Enrollment. One exception: termination of a domestic partnership is processed whenever the form arrives. Death of a dependent should be reported as soon as reasonably practical, with no fixed deadline.⁵

Filling Out the Form

The EC-2 is a single page divided into labeled blocks. Work through them in order.

Enrollment Type

At the top, check one box: Retirement, Qualifying Event, or Open Enrollment. If you check Retirement or Qualifying Event, write the date the event happened, and for a qualifying event add a short description such as “spouse lost employer coverage on 3/15/2026.”⁶ Leaving this blank or choosing the wrong box is one of the fastest ways to get the form returned.

Retiree Data

Enter your full legal name, Social Security number, mailing and residence addresses, marital status, gender, date of birth, former employer department and bargaining unit, phone numbers, and email. If you are adding a spouse or partner, their name, Social Security number, and date of birth go in this block as well.⁶ Check Social Security numbers twice. A transposed digit will hold up processing.

Coverage Start Date

Pick one of three options for when coverage and premium deductions begin:⁶

Day of the event. Coverage starts on the event date, and premium contributions start the first day of the pay period containing that date. This is the default if you leave the choice blank.
First pay period after the event, meaning the 1st or 16th of the month following the event.
Second pay period after the event, meaning the next 1st or 16th after that.

For adoption, birth, guardianship, marriage, and new domestic or civil union partnership, you can choose any of the three if you file within the deadline. If you enroll in the Humana Medicare Advantage plan, coverage starts the first of the month following the signature date on your EC-2, regardless of the event date.⁷

Plan Selection

Mark the specific plans you want for yourself and each dependent. You can enroll in only one medical plan. The 2026 options are:⁶

Medical: HMSA PPO 90/10, Kaiser Permanente HMO, or Humana Medicare Advantage.
Prescription drug: CVS Caremark for HMSA or Humana enrollees, or SilverScript for Medicare-eligible retirees. Kaiser bundles drug coverage into its medical plan, so no separate drug selection is needed with Kaiser.
Dental: Hawaii Dental Service.
Vision: Vision Service Plan.
Life insurance: Securian Life, retiree only, no dependent coverage.

For each plan line, mark Self, Two-Party, or Family to show who is covered, or mark Cancel/Waive to drop that benefit. One trap worth flagging: if you choose HMSA or Humana for medical and want prescription drug coverage, you must separately check CVS Caremark. Skipping it leaves you with no drug plan.⁶

Dependent Information

List each dependent’s full name, date of birth, Social Security number, relationship, and gender. Indicate whether you are adding, continuing, or removing each one, and mark the plans they should be enrolled in. The form has room for three dependents; attach a separate sheet if you have more.⁶

Medicare, Other Insurance, and Signature

If you or a dependent is eligible for Medicare Part A and B, report that in the Medicare block, including the Medicare claim number and effective dates. Hawaii law requires EUTF retirees and eligible dependents to enroll in Medicare Part B once they qualify, and failure to do so can result in disenrollment from EUTF medical and prescription drug plans.⁸

In the Other Insurance block, list any other coverage held by you or your dependents, including plan type, carrier, and subscriber name. Then sign and date. If a dependent is enrolling in or dropping Humana, Kaiser Permanente HMO, or CVS/SilverScript, that dependent also has to sign.⁶

Documents to Attach

When adding dependents for the first time, include copies of:⁶

Spouse or partner: marriage certificate, civil union certificate, or notarized domestic partnership agreement.
Child: birth certificate, plus a guardianship or adoption decree if applicable.
Medicare enrollees: proof of Medicare Part B enrollment showing your MBI number and effective date. Your Medicare card or a Social Security Administration letter works.

Social Security numbers are required for every newly added dependent. Supporting documents follow the same deadline as the EC-2 itself: 45 days from the event for most qualifying events, with the longer windows for births, retirement, and disenrollment due to other coverage. For Open Enrollment changes, documents must be postmarked by October 31.⁶

Where to Send It

Mail or deliver the signed form and attachments to:⁹

EUTF
201 Merchant Street, Suite 1700
Honolulu, HI 96813

The Member Self-Service Portal is available only to active employees, not retirees, so plan on a paper submission.¹⁰ For questions before filing, call EUTF at 808-586-7390 on Oahu or 1-800-295-0089 toll-free. The office is open Monday through Friday, 7:45 a.m. to 4:30 p.m., excluding state holidays.⁹

After You File

EUTF staff review the form for completeness, verify the qualifying event, and update your enrollment. No specific processing timeline is published, and the EUTF notes that enrollment may not be processed right away; if you need medical care or a prescription before your new cards arrive, contact the office by email.¹¹ Insurance carriers mail new ID cards after the EUTF updates your enrollment, so expect some lag between filing and the cards showing up.

Your monthly cost depends on the plans you pick, how many people are covered, and the employer contribution tied to your years of credited service and ERS membership date. Current premium tables and contribution tiers are published in the EUTF’s annual Retiree Health Benefits Highlights Guide.¹²

1
Hawaii Employer-Union Health Benefits Trust Fund. EUTF Retiree – Enrollment Overview
2
Hawaii Employer-Union Health Benefits Trust Fund. All EUTF Forms
3
Hawaii Employer-Union Health Benefits Trust Fund. 2025-26 EC-1 Ratified Enrollment Form
4
Hawaii Employer-Union Health Benefits Trust Fund. Open Enrollment
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Hawaii Employer-Union Health Benefits Trust Fund. EUTF Retirees Qualifying Events
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Hawaii Employer-Union Health Benefits Trust Fund. EC-2 Hawaii Enrollment Form
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Hawaii Employer-Union Health Benefits Trust Fund. Future Retirees – Enrollment Overview
8
Hawaii Employer-Union Health Benefits Trust Fund. Why Am I Required to Enroll in Medicare Part B When I Am Eligible?
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Hawaii Employer-Union Health Benefits Trust Fund. Contact Us
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Hawaii Employer-Union Health Benefits Trust Fund. Member Self-Service Portal
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Hawaii Employer-Union Health Benefits Trust Fund. EUTF Active – Enrollment Overview
12
Hawaii Employer-Union Health Benefits Trust Fund. 2026 Retiree Health Benefits Highlights Guide