Please use our online Small Group Enrollment Checklist. Quick links are provided to assist you with locating additional forms necessary for group submission. Please be sure to use this checklist when submitting new groups.
Cut Off Submission Dates:
For New Business all forms must be completed and received no later than the 20thof the month prior to the effective date.
A 15th of the month effective date is due by the 5th of the month.
For Existing Business (making plan changes) all forms must be completed and received no later than the 15th of the month prior to the effective date.
For Lumenos Business all forms must be completed and received no later than the 1st of the month prior to the effective date.
The turnaround time for the successful implementation of a High Deductible Health Plan can be in excess of 30 days in preparation for the desired effective date. In the event that all forms are not completed and received within this timeframe, the client will experience delays in processing, group loading and distribution of ID Cards. In cases of clients selecting a High Deductible Health Plan (regardless of whether a case is new or renewing), our consumers will need to complete an Employee Enrollment Application in its entirety as part of the process, in addition to any other plan-specific documents. Completing an Employee Enrollment Application as part of a client’s renewal, will replace the current process of completing a Member Change Form. Any missing information and/or documentation could result in the effective date being moved to the next available date.
Please consult your assigned representative for additional details.
Any missing information will result in the effective date being moved forward to the next available date.