Large group enrollment hub
Forms and documents you’ll need to get your clients set up with Harvard Pilgrim
Contact your sales executive if you have questions or need assistance.
Deadline for new group submissions: 10 business days prior to effective date.
New Group Paperwork:
- CDH Authorization Form
- Group Information Form
- Enrollment Form
- Plan Sponsor Certification
- Identification of Third Party Authorization/Employer Group Vendor Designation Form
- Express Enrollment Template
- MA Domestic Partner Amendment
- ACH Authorization Form
TIPS:
- Submit only COMPLETE cases in one email. Incomplete submissions require follow-up emails and cause delays in processing. Incomplete cases are placed last in the processing queue.
- Account name should appear in subject line of all correspondence.
- For the quickest turnaround in processing enrollments and obtaining member ID numbers, be sure to use the Express Enrollment Template and include with your submission. We need the enrollment details for final rating purposes.
Questions concerning New Group Submissions should be directed to HPNewBusinessSales@point32health.org
Deadline for new group submissions is the 25th of the month.
New Group Paperwork:
- CDH Authorization Form
- Group Information Form
- Premium Deposit Statement
- ME – HMO Domestic Partner Amendment
- ME – PPO Domestic Partner Amendment
- Enrollment Form
- Plan Sponsor Certification
- Identification of Third Party Authorization/Employer Group Vendor Designation Form
- Express Enrollment Template
- ME Health Coverage Waiver
- ACH Authorization Form
TIPS:
- Submit only COMPLETE cases in one email. Incomplete submissions require follow-up emails and cause delays in processing. Incomplete cases are placed last in the processing queue.
- Account name should appear in subject line of all correspondence
- Indicate the Bill type (List Bill/Age Banded or Composite)
- For the quickest turnaround in processing enrollments and obtaining member ID numbers, be sure to use the Express Enrollment Template and include with your submission. We need the enrollment details for final rating purposes.
Questions concerning New Group Submissions should be directed to HPNewBusinessSales@point32health.org
Deadline for new group submissions: 15 business days prior to the effective date, except when you submit plans through HPOQ — then it is 10 business days prior to the effective date.
New Group Paperwork:
- CDH Authorization Form
- Group Information Form
- Premium Deposit Statement
- Enrollment Form
- Plan Sponsor Certification
- Identification of Third Party Authorization/Employer Group Vendor Designation Form
- NH Domestic Partner Amendment
- ACH Authorization Form
- NH Health Coverage Waiver
TIPS:
- Submit only COMPLETE cases in one email. Incomplete submissions require follow-up emails and cause delays in processing. Incomplete cases are placed last in the processing queue.
- Account name should appear in subject line of all correspondence.
- Use Express Enrollment for fastest turnaround time on enrollments and obtaining member ID’s. Login to HPHConnect to upload on your own once the account has been installed.
Questions concerning New Group Submissions should be directed to HPNewBusinessSales@point32health.org
Deadline for new group submissions: 10 business days prior to effective date.
New Group Paperwork:
- CDH Authorization Form
- Group Information Form
- Enrollment Form
- Plan Sponsor Certification
- Employer Group Vendor Designation Form
- Express Enrollment Template
- RI Domestic Partner Amendment
- ACH Authorization Form
TIPS:
- Submit only COMPLETE cases in one email. Incomplete submissions require follow-up emails and cause delays in processing. Incomplete cases are placed last in the processing queue.
- Account name should appear in subject line of all correspondence.
- For the quickest turnaround in processing enrollments and obtaining member ID numbers, be sure to use the Express Enrollment Template and include with your submission. We need the enrollment details for final rating purposes.
Questions concerning New Group Submissions should be directed to HPNewBusinessSales@point32health.org