ENROLLMENT FORM FOR ACTIVE EMPLOYEES - hawaii 2025

1. Click ‘Get Form’ to open the ENROLLMENT FORM FOR ACTIVE EMPLOYEES - hawaii in the editor.
2. Begin by filling out the 'Event' and 'Event Date' fields. Clearly specify the event type, such as marriage or birth, and enter the corresponding date.
3. Input your personal information in section 3, including your last name, first name, middle initial, social security number, birth date, gender, marital status, and contact details.
4. If applicable, provide your spouse's social security number if they are a state or county employee or retiree.
5. List your dependents' names and birth dates in section 5. If you have more than three dependents, indicate this on a separate sheet.
6. Select your plan choices in section 9 by checking the appropriate boxes for medical, dental, and vision coverage options.
7. Complete any additional sections relevant to state employees regarding premium conversion plans and provide necessary signatures before submitting.

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