Getting Started: What Every Plan Administrator Should Know

1617 views March 19, 2018 May 6, 2020 ghclienthelp 35

Welcome to GroupHEALTH Benefit Solutions!

We are pleased to have the opportunity to meet your benefit needs through our flexible product choices and create a WOW experience.

Important Information Every Plan Administrator Should Know

We have created this Plan Administrator Knowledge Base to help you understand how to administer the benefit plan your company has selected through GroupHEALTH. Additionally, it will assist you in guiding your members through the various processes that will involve them. Your Benefits Handbook contains the details of all the terms and conditions of the benefits provided.

The information in this Knowledge Base does not override the terms and provisions of your Group Policy. You are responsible for administering your plan in accordance with the terms outlined in your contract. Your company may not have applied for all benefits described in this Guide, therefore, please refer to your Benefits Handbook for the actual benefits contained in your plan.

This Knowledge Base, along with an occasional reference to your Benefits Handbook, available electronically to you on our administration system, should provide sufficient information for most of your needs.

Your Responsibilities as Plan Administrator

As the Plan Administrator for your group benefits program, you maintain your employee records through our administration system WEBS™ Online and we produce your monthly billing statements accordingly. In addition, you are responsible to:

  • Review monthly billings statements and ensure premium payment is made on-time and as billed;
  • Report all new enrollments and terminations to GroupHEALTH within 31 days of their effective date;
  • Ensure that all applications and changes are completed fully and correctly, signed by the member.  The applicable changes need to be forwarded to GroupHEALTH within 31 days;
  • Ensure that all members are covered for the insurance to which they are entitled;
  • Provide guidance when a member has a claim; and
  • Direct members to their digital Benefits Handbook and oneCard

Tip!

Please provide GroupHEALTH with all necessary member information on a timely basis to avoid any claim issues and to calculate your benefit premiums. When corresponding with GroupHEALTH, please include your company name and policy number in communication. When corresponding about a specific member, please include the member’s full name and identification number.

 

Maintaining Accurate Records

The maintenance of accurate records for each member is a critical part of your role as Plan Administrator. You are responsible to:

  • Keep the original signed Enrollment Card for each eligible member in a secure, accessible location.
  • Securely store any legal documents pertaining to changes of beneficiary designation.
  • Keep track of any disabled members who have qualified for Waiver of Premium, to ensure that records remain accurate. If the member’s status changes (i.e. member ceases to be disabled, or retires, etc.), eligibility for Waiver of Premium will be affected and GroupHEALTH must be notified.

GroupHEALTH will require the original, signed Enrollment Card (or WEBS™-generated Enrollment Application) in the event of a Life, AD&D, ASI, Dependent Life or Critical Illness claim. If the original cannot be produced or if only a copy is available, the claim payment may be delayed, or paid to member’s estate instead of their designated beneficiary.

Tip!

At least twice per year, audit your Enrollment Cards to confirm that no eligible member has been omitted from enrollment in your benefits plan, as well as, remove any individuals who have ceased employment or are no longer eligible. Contact your Client Services Representative or Benefits Specialist immediately if you find any discrepancies.

 

Reporting a Plan Administrator Change
If the responsibility for administration of your group benefits plan changes hands, please advise your Client Services Representative or Benefits Specialist immediately. Please provide the full name and contact information of the new Plan Administrator with whom GroupHEALTH should correspond.

Plan Cancellation
In the event that this group benefits plan is no longer required, GroupHEALTH will require 30 days written notice of cancellation. All outstanding adjustments should be submitted prior to or along with the cancellation letter. GroupHEALTH will perform a final Billing reconciliation.

Disclaimer!

This Knowledge Base does not override the terms and provisions of your Group Policy.  You are responsible for administering your plan in accordance with the terms outlined in your contract. Your company may not have applied for all benefits described in this Guide. Please refer to your Benefits Handbook for the actual benefits contained in your plan.

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