Get Hi Ec-1 2017-2025

The HI EC-1 form is crucial for employees seeking to enroll in health benefits through the Employer-Union Health Benefits Trust Fund (EUTF). This guide provides clear and structured instructions for completing the form online, ensuring all necessary information is accurately entered to avoid delays.

Follow the steps to successfully complete the HI EC-1 form.

1. Click ‘Get Form’ button to obtain the HI EC-1 form and access it in your preferred online editor.
2. Begin by completing Section 1 – Employee Data, which includes entering your last name, first name, middle initial, and contact information including home, mobile, and work phone numbers.
3. Provide your mailing and residence address. If these differ, ensure both are inputted to facilitate proper correspondence.
4. Indicate if you are a new hire or newly eligible by marking the appropriate box and entering the effective date of your status change.
5. If applicable, mark the Open Enrollment box only during designated enrollment periods.
6. Mark the Termination box if you are resigning, and specify your last day of employment.
7. If this is your first enrollment with the EUTF, input your Social Security Number and your dependents’ SSNs.
8. Fill in your gender and birth date, noting that these are necessary for first-time enrollment.
9. If there is a mid-year qualifying event, check the appropriate box and specify the event date. Common events include marriage, birth, and address changes.
10. Indicate your marital status and provide the date if married, in a civil union, or domestic partnership, attaching any required documentation.
11. Complete Section 2 – Coverage and Contribution Start Selection by choosing one of the options provided based on your qualifying event.
12. In Section 3 – Plan Selection, check all relevant plans to enroll in. You may choose a medical, dental, and vision plan, ensuring that your selections comply with the rules outlined.
13. If enrolling dependents, complete Section 4 by providing their names, birth dates, and Social Security Numbers, marking the relationships correctly.
14. Consult Section 5 to disclose any other health insurance you or your dependents may have.
15. Finalize your application by signing in Section 6, certifying the accuracy of the information provided. Submit the completed form to yourPersonnel Office or Department Personnel Officer for necessary verification and processing.

Complete your HI EC-1 form online today to ensure your health benefits are secured.