Hawaii ec 1 2025

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4.8 out of 5

87 votes

The document provides detailed instructions for completing Form EC-1, which is used by employees to enroll in health benefits through the Hawaii Employer-Union Health Benefits Trust Fund (EUTF). It outlines the necessary employee and dependent information required, including personal data, qualifying events, coverage selections, and authorization. The form must be submitted within specified timeframes to ensure proper processing of health benefits.

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Click ‘Get Form’ to open the hawaii ec 1 in the editor.
Begin with Section 1: Employee Data. Clearly enter your Last Name, First Name, and Middle Initial. Provide your contact information including home, mobile, and work phone numbers along with your email address.
Fill in your address details. If your residence differs from your mailing address, ensure both are included for accurate correspondence.
Indicate if you are a New Hire/Newly Eligible by marking the appropriate box and entering the effective date of hire or status change.
In Section 2: Coverage and Contribution Start Selection, choose one of the three options based on your qualifying event to determine when coverage begins.
Proceed to Section 3: Plan Selection. Mark all plans you wish to enroll in, ensuring you select only one medical/prescription drug plan.
Complete Section 4: Dependent Information by listing all dependents you want enrolled and providing their necessary details.
Finally, review Section 6: Employee Authorization and Signature. Sign to certify that all information is accurate before submitting through your personnel office.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (87 Votes)
2003	4.4 Satisfied (41 Votes)

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What is the EC 1 enrollment form for health benefits?

The EC-1 Enrollment Form is used by employees to select and make changes to their health benefit plans. It covers enrollment types, coverage start dates, plan selection, dependent information, and other insurance details. This file is essential for employees to manage their health benefits efficiently.

What is the EC1 form?

The form, known as the EC1 form, has been designed to give you the opportunity to set out the details of your extenuating circumstances. Any evidence in support of your claim should be submitted with the form and submitted to your course director/co-ordinator.

Is the Hawaii Declaration Form mandatory?

All agricultural items must be declared on the Plants and Animals Declaration Form, which is distributed and collected by flight attendants prior to landing in Hawaii. All agricultural items must be presented for inspection at the Agricultural Inspection Counter located near the exits in the baggage claim area.