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Enrollment Transactions

The following information is provided by Gallagher Benefit Services (GBS), WSHG’s Central Benefits Administrator

Enrollment Transactions

Gallagher Benefits Services 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.

Enrollment/change forms:

1. Please check forms for completeness:
• Date of hire for new effectives
• Effective date
• Termination date
• Group Number
• Date(s) of birth
• Address
• 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 Invoices

• 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.

General Items

  • We prefer that you mail forms to GBS. If it is an emergency enrollment, you can fax the form. (It is extremely difficult to read faxed forms.) If you have secure email, you can email transactions to [email protected]
  • Senior plans do not allow retroactive transactions.
  • The retiree needs to sign and date the Senior plan enrollment form prior to the effective date.
  • Senior Plans require the signature of the retiree in order to cancel the coverage. (BCBS requires that the retiree complete a voluntary cancel form prior to the term date. If that is not possible, then a 21 day letter has to be completed and mailed to the retiree 21 days prior to the term date.)

• 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.  Weekly file transfer will then update the address at the carrier level.

• Employees/retirees need to contact customer service if they need new ID cards (In case of lost or missing ID cards)

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