Large Group Enrollment Hub - Harvard Pilgrim Health Care

Here are the 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.

Massachusetts

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

Maine

Deadline for new group submissions is the 25^th 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

New Hampshire

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 Small Group Submission Deadlines Q4 2021 & Q1 2022

NH Small Group Submission Overview

NH Domestic Partner Amendment

ACH Authorization Form

NH Health Coverage Waiver

2022 Large Group Product Guide

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.
Start the group setup by following the Submit Plans process through HPOQ
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

Rhode Island

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