- ABOUT WSHG
- EMPLOYEES & RETIREES
The following information is provided by Group Benefits Strategies (GBS), WSHG’s Central Benefits Administrator
Group Benefits Strategies processes all Harvard Pilgrim, Blue Cross Blue Shield, and Tufts EPO enrollment transactions directly online with these health plans. Group Benefits Strategies mails all Fallon forms to Fallon as it does not have online access. Also, GBS mails all Tufts Medicare plan forms to Tufts.
It is very important that the enrollment forms are complete. When GBS receives incomplete forms, it delays processing, which then delays the employee’s enrollment, change, etc.
It is also very important that only eligible employees and retirees are enrolled in the employer group’s plans. As part of WSHG, employers are required to request and obtain government issued marriage certificates, birth certificates, divorce agreements for new hires and new spouses and other dependents enrolling in health benefits plans.
1. Please check forms for completeness:
• Date of hire for new effectives
• Effective date
• Termination date
• Group Number
• Date(s) of birth
• PCP for HMO’s
• Subscriber signature (new effectives, changes, voluntary cancellations)
• Legible handwriting
2. Late enrollees may enroll for coverage during open enrollment or at the time of a qualifying event. When enrolling someone off anniversary, the effective date should be the date of the qualifying event. The health plans require documentation when adding someone off anniversary.
• Loss of coverage documentation
• Adoption/placement papers for an adopted dependent
• Court order for legal guardianship
• Divorce decree when necessary
• Additional information as requested by the health plan
Note – There is a time restriction when enrolling someone due to a qualifying event.
The enrollee should notify you within 30 days of the qualifying event. The health plans allow 60 days from the date of the qualifying event for the transaction to be processed.
There are no retroactive cancelations for any of the Senior plans.
• GBS runs the WSHG invoices on the 10th of each month for payments due to WSHG by the 1st of the next month.
• Midmonth premium transactions are calculated by using the wash rule (15/16 day rule).
• For cancelations: if the cancel date is anywhere from the 1st of the month, the account is not charged for the entire month. If the cancel date is from the 16th to the end of the month, the account is charged for the entire month.
• For new adds: if the effective date of enrollment is from the 1st to the 15th of the month, the account is charged for the full month. If the effective date is from the 16th to the end of the month, the account is not charged for the month.
• Sometimes GBS receives faxed birth certificates, Medicare cards, full time student documentation, loss of coverage documentation, etc., without any notes or cover sheets. Occasionally it is extremely difficult to identify where this information belongs. It would be helpful to have a cover sheet.
• You can email address changes to GBS. GBS does NOT update the health plans. However, employees and retirees must call customer service to update their addresses.
• Employees/retirees need to contact customer service if they need new ID cards (In case of lost or missing ID cards)