State of Hawaii     

HAWAI`I EMPLOYER-UNION HEALTH BENEFITS TRUST FUND

Forms may be downloaded.  Additional forms will be on-line as they become available.
 

• EC-1 Print and Fill Form "Revised July 2010"       Effective  August 1, 2010
   

• EC-1 Print and Fill Form Instructions       Effective  October 2009
   

• PCP Election Change Form (State of Hawaii Employees Only) Link to DHRD Premium Conversion Plan Forms       Effective  July, 2008
   

• EC-2 Print and Fill Form "Revised August 2010"       Effective  August 1, 2010
   

• Authorization for Release of Protected Health Information Print and Fill Form          
   

• Authorized Leave of Absence without Pay          
   

• Direct Deposit Authorization Print and Fill Form        Effective  July, 2007
   

• Disability Certification for Dependent Children
   

• Domestic Partner Forms       Updated  July, 2008
   

• EC-1H HSTA Enrollment Form for Active BU05 & 45 Employees       Effective  January 3, 2011
   

• EC-2H Enrollment Form for HSTA Retirees       Effective  January 3, 2011
   

• HSTA COBRA Election Form       Updated  Updated January 11, 2011
   

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