Instructions for new Blue Cross groups of 1 to 19 eligible employeesBlue Cross Small Group Summary of Benefits
To obtain final rates, the following must be completed and returned to GNAC by the 15th of the month PRIOR to your requested effective date, which is always the 1st of the month:
1. Complete and return the Blue Cross & Blue Shield of RI New Business Underwriting Checklist. To avoid delays, please complete checklist in full and provide tax documentation requested and read the definitions of Eligible Employees and Small Employers
2. Eligible employees must complete Membership Application(s) . Eligible employees who choose to waive coverage for themselves, their spouse or dependent(s) must sign the Small Employer Waiver Form/Certification. (For the definition of an "Eligible Employee" see Appendix I on the Blue Cross & Blue Shield of RI New Business Underwriting Checklist.)
3. Sign and return the white copy of the Insurance Payment Contract.
4. Complete and return the Broker of Record Letter to GNAC.
5. Complete and sign the Sales Agreement.
6. Include 1 month's premium (and dental if applicable) payable to: The Good Neighbor Alliance Corporation or GNAC.
Once Enrolled:
New Eligible Employees: May enroll after completing your company's designated wait period.
Example: Group with a 60 day wait: Date of Hire: December 20
Effective Date: March 1To avoid enrollment processing delays, be sure:
- Membership applications are completed in full. (EX.:social security no., date of birth, effective date, date of hire, and signed and dated.)
- To include premium payment for the remaining quarter for medical and/or dental payable to GNAC.
- Waiting periods are satisfied.
- Eligible employees who choose to waive coverage for themselves, their spouse, or dependent(s) must sign and return the Small Group Waiver Form/Certification to GNAC.
* Late Entrants: Employees and/or dependents that do not enroll at time of eligibility must wait until your group's next renewal and must have met your group's waiting period. Exceptions are qualifying events that include a new marriage, loss of spousal coverage, change in employment status, birth, adoption, or legal guardianship. (Documents Required)
* Terminations: GNA must receive the request by mail, fax, or email within 30 days of the employee's termination stating the termination date and the reason for termination. All terminations are effective the last day of each month.
* Changes: Cannot be taken over the phone. You may mail, fax or email your change to GNAC (Ex.: terminations, address, name, etc.)
All enrollments, terminations, changes must be submitted to GNA within 30 days of the event or Blue Cross will deny the request.
* Quarterly payments are due: December 15 - March 15 - June 15 -
September 15 -* Automatic termination: will result if your payment is not received within 5 days of due date. If the 15-days of due date. If the 15-day period expires and any premium remains unpaid, terminations will be retroactive to the last day of the month for which premium has been paid.
Dental Insurance
To Receive a dental quote, please fill out the Census Form and check off Blue Cross Dental or Delta Dental (if you have 3 or more employees interested in Delta Dental).
Groups with 1 or 2 employees: Premier Blue Option 2 is available through Blue Cross Blue Shield of RI.
Groups with 3 or more employees: Several plan options are available, please call our office for a quote.
All Forms must be returned to GNAC no later than the 23rd of the month, for coverage to be effective the 1st of the following month:
- Amendment to Sales Agreement Form
- One month's premium for medical and dental (if applicable) payable to:
THE GOOD NEIGHBOR ALLIANCE CORPORATION or GNAC.