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WSHG Health Plan Enrollment Retroactive Policy


− Group Benefits Strategies (GBS) provides each Participating Governmental Unit with a monthly bill for health plans that includes a list of enrollees by health plan.

− WSHG asks each Participating Governmental Unit to (1) pay as billed, (2) review the membership lists each month and (3) inform GBS’s Manager of Enrollment & Billing of any disputed enrollments.

− Health plans permit retroactive changes up to 60 days following the event (termination or enrollment).

− HPHC makes capitation payments to physicians as well as fee payments. At this time these capitated amounts cannot be recovered once paid.


The WSHG’s policy is 60 days retroactivity for enrollment transactions. In all cases, including the exception below, reimbursements to governmental units will be net of any expenses that cannot be recovered from health plans, healthcare providers, reinsurer, or other.

Policy Exception:

No exceptions will be made to the 60-day retroactive except for the following –

Terminations because of death
Health plan terminations will be made beyond the 60-day retroactivity period to the date of death of the member when the Participating Governmental Unit provides Group Benefits Strategies (GBS) with a valid death certificate. Fees and payments withheld by the health plan, if any, and reinsurance premiums will be subtracted from the amount owed to the governmental unit. In the case of health plans with monthly capitation payments to providers, the WSHG will make an estimate of these payments made on behalf of the member since his/her death and will subtract this from the premium credited to the governmental unit. The estimate will not be a subject of dispute.

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