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Home > Employer > Frequently Asked Questions

Frequently Asked Questions

The following information pertains to employer group plans only (not applicable for nongroup or retiree plans).

HPHConnect

HPHConnect is our way to help employers manage health care administration faster, more accurately and more conveniently. This Web-based service will allow you to download a roster, verify new enrollees, edit/add/disenroll subscribers and more.

  1. What is the turnaround time for enrollment transactions to be processed in HPHConnect?
    Once the employer group approves a transaction, it’s processed within 24 hours, ensuring a timely and accurate enrollment experience for the member. The turnaround time may vary in some instances.

  2. I processed an enrollment with a future effective date and now cannot find the person anywhere in the active roster.
    The active roster reflects the roster as of today’s date. To see a future roster, use the “download roster” function and change the date to reflect the future effective date.

  3. Can the employer group change a PCP using HPHConnect?
    Employer are unable to change PCP information, however Members can change their PCP at any time using HPHConnect. We encourage members to call Member Services directly to ensure they know the impacts of making a PCP change, such as new referrals and potential claim issues.

  4. How do I disenroll an entire contract?
    Choosing the “Disenroll Contract” button at the bottom of the Enrollment Summary screen allows you to disenroll the subscriber (including all dependents) from Harvard Pilgrim coverage.

  5. How do I disenroll a dependent?
    Choosing the “Disenroll” link next to Dependent Profile will take you to the Enrollment Updates/Disenroll Dependent screen, where you will be asked to enter the Maintenance Effective Date and Change Reason for disenrollment.

Enrollment

  1. How do I report membership changes including additions, termination or changes?

    Our standard method of enrollment is HPHConnect (our secure Web- based enrollment tool), which performs online validation to prevent the submission of incomplete or inaccurate enrollment transaction. HPHConnect provides faster processing time and improved service to our employers and their employees.

    We also offer Electronic Data Interchange (used by employers to submit batch enrollment transactions electronically) when approved and a Harvard Pilgrim paper enrollment/ change form as other enrollment method options.

  2. Where do I send the Enrollment forms?
    Forms should be mailed to:

    Harvard Pilgrim Health Care
    PO BOX 9185
    Quincy, MA 02269

  3. What is the notification period for adding or making a change?
    Notification of an enrollment, re-enrollment or change request needs to be received within 60 days of the qualified effective date. If the request is more than 60 days after the effective date, coverage will be denied and the requestor must wait for another qualifying event or next open enrollment period for further consideration.

  4. What is the notification period for terminating a member’s policy?
    Harvard Pilgrim requires notification of enrollment terminations within 60 calendar days of the requested termination date. * If notice of a termination is received more than 60 days after the requested termination date, the termination date will be automatically processed 60 days retroactively, beginning on the date the request was received by Harvard Pilgrim.

    * In accordance with NH state requirements, Harvard Pilgrim will process terminations received from NH employers no more than 30 days retroactively from the date of receipt of the termination.


  5. When is coverage terminated?
    Coverage ends at midnight on the date a member’s coverage is terminated. There is no coverage for any services received after midnight on the date a member’s coverage terminates. All authorizations for services issued by Harvard Pilgrim or participating providers assume confirmation of membership and are invalid after termination of membership including retroactive terminations.

  6. As a result of Federal Health Care Reform changes, do you still verify full-time students?
    Harvard Pilgrim no longer performs an annual Dependent Verification Process. Eligible dependents will be covered to the day prior to their 26th birthday. Employer accounts determine dependents’ eligibility based on Federal Health Care Reform for dependent children (age 18 and over).

    Child dependent coverage – Harvard Pilgrim will provide coverage to child dependents until age 26. This change is effective for all group renewals after September 23, 2010.

    A subscriber or spouse who has a full-time HMO student dependent attending school outside the state in which the subscriber resides must register the full-time student in advance with Harvard Pilgrim by calling Member Services at (800) 333-4742 to obtain special coverage as listed in the member’s Handbook.

Billing

  1. Can I receive my invoice Online?
    Harvard Pilgrim provides a free online billing service to employer groups via HPHConnect. Online billing allows you to manage you invoice in a secure environment, making bill payment quicker, easier and more accurate.

    With online billing, you will receive a preliminary bill on or about the 10th of each month. This provides you with a “preview” of what your next month’s bill will look like, allowing you to focus on any adjustments that need to be made.

    Harvard Pilgrim online billing also lets you select a final bill date to align with your business processes. The final bill will reflect your premium due based on all membership changes made since your preliminary bill was presented. You will be allowed to choose any day between the 11th and the 25th of the month as your final bill date.

    For more information about online billing, please contact the Account Services department at (800) 637-4751.

  2. When can I expect to receive my invoice?
    If an employer group is unable to receive invoices online through HPHConnect, Harvard Pilgrim will provide a paper bill each month and mail it approximately 15 days before the payment due date. Full premium payment is due on the first of the month for that coverage month (i.e. payment due by May 1st for the month of May).

  3. Where do I send my premium payments?
    Please forward a check, along with the printed coupon from the summary page of you online or paper invoice.

    Harvard Pilgrim Health Care
    PO Box 970050
    Boston, MA 02297-0050


  4. How can I pay my invoice?
    The following methods may be used to remit your premium payments:
  • Check: Harvard Pilgrim uses an automated lock box service to ensure accurate and timely processing of your payment.When paying for multiple divisions with the same check, please include a separate coupon for each division and indicate the amount to be applied to each division.
  • Electronic Funds Transfer through online billing
  • Harvard Pilgrim also accepts premium payments electronically by wire or Automatic Clearinghouse (ACH) transfer.

Common member questions

  1. When will I receive my ID card?
    You should receive your ID card in seven to 10 business days from the time your enrollment is processed. However, your coverage is effective on the date your employer specifies (or the date our Sales department specifies if you are not applying through an employer group). You can order your Harvard Pilgrim ID card through HPHConnect.

  2. What are the different out-of-pocket expenses?

    Premium: The premium is the monthly cost of your insurance. Most employers pay part of it and deduct the remainder from your paycheck. Your employer determines the percent you are required to pay. If you do not have direct coverage — through an employer — you will usually pay the entire premium. Best Buy plans generally have the lowest premiums, followed by HMO, POS and PPO Plans.

    Copayment: A fixed amount that you pay each time you receive a covered service, such as a doctor's office visit or a covered prescription.

    Deductible: A set amount of money that you may be responsible for each year for certain kinds of medical services. Once you have paid the yearly deductible in full, you are covered for those services for the rest of the year. However, you may need to pay copayments or coinsurance.

    Coinsurance: A fixed percentage of covered medical charges that you may be responsible for paying. The coinsurance amount will be specified in your Schedule of Benefits or Summary of Benefits. An example of coinsurance could be that your health plan covers 80% of covered medical charges and you are responsible for the remaining 20%.
    Login to HPHConnect to view your Schedule or Summary of Benefits for details on your copayment, deductible and coinsurance.

  3. How do members know if the deductible applies to a specific service?
    Login to HPHConnect: HPHConnect for Employers enables employers to access their specific Summary of Benefits and member Handbook and review a list of commonly used benefits and the amount members pay when they receive care (copays, deductibles, etc.)

    HPHConnect for Members provides secure access to personalized information that will help them understand their coverage and costs.
    Members can review a list of commonly used benefits and the amount a member owes when they receive care (copays, deductibles, etc.)
    Members and employers may also print their specific Summary of Benefits and member Handbook for easy reference.

  4. How do members know what has been applied to their deductible?
    Login to HPHConnect to view your Activity Summary for details on your copayment, deductible and coinsurance. This will include information about any amount that the member is responsible to pay to the provider

  5. How do members know when they have reached their deductibles?
    Login to HPHConnect to view your Activity Summary for details on your copayment, deductible and coinsurance. This will include information about any amount you are responsible to pay to the provider.

  6. What is an Activity Summary?
    An Activity Summary is not a bill. It is a statement that members who are on cost-sharing plans receive after receiving care. It lists services they received, the amount billed by their provider (doctor, hospital or other health care professional), and the amount paid or denied by Harvard Pilgrim. It will include information about any amount that the member is responsible to pay to the provider.

  7. Am I covered when I'm traveling?
    Yes. If you become sick or injured outside of the Harvard Pilgrim service area, Harvard Pilgrim covers any unforeseen care you may need. Examples include: earaches, flu, poisoning, broken bones, medical emergencies and prescription drugs. You may be responsible for paying out-of-pocket expenses. If you paid out-of-pocket, make sure you obtain a detailed copy of your claim in order ensure reimbursement of your expenses. When you return from traveling, you should contact your PCP and Harvard Pilgrim. Please note: Routine or preventive care (i.e., care that can be delayed until you return from traveling) is not covered.