For OR/WA Brokers: 2017 New Case Submission Rules for Groups of 1-50

This is a friendly reminder that Health Net is looking to you to ensure that the onboarding process for new groups is as seamless as possible.

To achieve this, Health Net must receive the completed, signed, and dated submission documents by the dates set. Below are documents that are required at the time of new case submission.

Oregon – Groups 1-50

  • Live check, copy of check, or check by fax/electronic check (first month’s premium)
  • Plan selections
  • Signed & completed Group Service Agreement (GSA) Application
  • Brokers must submit the Employee Census Enrollment sheet found on The Hub, with the understanding that the broker is responsible for retaining all signed and completed forms.
  • (1–5 enrollees) Form 132
    • Note: Groups that have not been in business long enough to have Form 132 may submit 2 weeks of payroll.
  • (All enrollees) Group Profile Form

Washington – Groups 1-50

  • Live check, copy of check, or check by fax/electronic check (first month’s premium)
  • Plan selections
  • Signed & completed Group Service Agreement (GSA) Application
  • Brokers must submit the Employee Census Enrollment sheet found on The Hub, with the understanding that the broker is responsible for retaining all signed and completed forms.
  • (All enrollees) Form 5208A/B
    • Note: Groups that have not been in business long enough to have Form 5208A/B may submit 4 weeks of payroll.
  • Enrollment and Eligibility Form

These items must be included by the submission cut-off date or will be moved to the next effective month. Click on the state below to see the Small Group (1-50) New Business Submission Date Timeline.

Oregon

Washington

If you have any questions regarding this announcement, please contact your Health Net Small Business Group Account Executive.

 

 

 

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