WHIT New Group Setup

WHIT provides cost effective employee benefit plans

WHIT NEW GROUP SETUP

WHIT and DiMartino Associates, Inc. are happy to work with participating groups' benefits consultants and/or insurance brokers. Please have your representative contact us for further information.

206-467-9408 (Seattle)
1-888-715-8000

	Cascade Medical Center Cascade Valley Hospital and Clinics Central Washington Hospital Columbia Basin Hospital East Adams Rural Hospital Enumclaw Regional Hospital Ferry County Memorial Hospital Garfield CountyPublic Hospital District Grays Harbor Community Hospital Harrison Medical Center Highline Medical Center Island Hospital Jerfferson General Hospital Kadlec Medical Center Kennewick General Hospital Kittilas Valley Community Hospital Lake Chelan Community Hospital Lincoln Hospital Mark Reed Hospital Mason General Hospital Mattawa Community Medical Clinic McKay Memorial Hospital Mid-Valley Hospital Morton General Hospital MultiCare Health System Neurological Center North Valley Hospital Ocean Beach Hospital Okanogan Douglas District Hospital Olympic Medicaal Centrer Othello Community Hospital Prosser Memorial Hospital Pullman Regional Hospital Quincy Valley Hospital Samaritan Healthcare Skagit Valley Hospital Stevens Healthcare Sunnyside Community Hospital United General Hospital Whidbey General Hospital Whitman Hospital and Medical Center Willapa Harbor Hospital

Last updated: August 02, 2007

The Trust greatly appreciates if all paperwork and initial premium checks are submitted in one batch to:


Susan McAdams Zenith Administrators, Inc. 201 Queen Anne Ave N Suite 100 Seattle. WA 981
Phone:	206-282-4100 ext: 470371
	1-800-426-5980
Fax:	206-352-9714
Email:	Smcadams@zenithadmin.com

At the same time, a copy of the paperwork and check must be submitted to:


Karni Adamson DiMartino Associates, Inc. 1301 5th Ave, Suite 3701 Seattle. WA 9810 Seattle. WA 981
Phone:	206-467-9408
	1-888-715-8000
Email:	Karni@dimarinc.com

All paperwork should be submitted PRIOR to the coverage month but no later than by the 5th of the coverage month. Any paperwork received after the 5th of the coverage month will be returned and no coverage will be placed.
NOTE: Zenith Administrators transmits eligibility to WDS and VSP on a weekly basis.

If your group is purchasing multiple converages, the premiums may be combined in one check payable to WHIT. However, please make sure that it is clear how much premium is applied to each coverage line.

REQUIRED ENROLLMENT INFORMATION -
WHIT (all new applicants)


...	WHIT Subscription Agreement
...	New Broker Partners should also provide a copy of the Broker of Record.

REQUIRED ENROLLMENT INFORMATION -
WASHINGTON DENTAL SERVICE (WDS)


...	Washington Dental Service Application
...	Washington Dental Service Enrollment Form for all enrolled employees
...	Zenith Administrators will also accept census enrollment if the census includes all the information requested on the WDS enrollment form.
...	Initial premium check payable to WHIT that matches the enrollment being submitted.

REQUIRED ENROLLMENT INFORMATION -
WILLAMETTE DENTAL GROUP (WDG)


...	Initial premium check payable to WHIT that matches the enrollment being submitted.
	Willamette Dental Enrollment Form

REQUIRED ENROLLMENT INFORMATION -
VISION SERVICE PLAN (VSP)


...	Group Vision Care Application
...	Census that includes:
	Name
	Social Security Number
	Dependents defined (for example spouse, 1 child, 2 children, spouse and 1 child etc)
...	Initial premium check payable to WHIT that matches the enrollment being submitted.

WHIT provides unique benefit plans to its members

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WHIT serves hospitals and healthcare related groups in the Pacific northwest

REQUIRED ENROLLMENT INFORMATION -
BASIC LIFE/AD&D and/or LONG TERM DISABILITY and/or VOLUNTARY ACCIDENT underwritten by Reliance Standard Life


...	Preliminary Plan Application
...	Confirmation of Plan Application
...	Copy of prior plan booklet.
...	Updated census, if needed, to the census provided when requesting a proposal.
...	Initial premium check payable to WHIT that matches the enrollment being submitted.
	NOTE: Reliance Standard considers the Basic Life/AD&D coverage to be 2 separate contracts. When you receive booklet drafts there will be separate booklets for Life and AD&D.

REQUIRED ENROLLMENT INFORMATION -
VOLUNTARY TERM LIFE underwritten by Prudential Financial


...	Policy Profile
...	Applications for each employee enrolling: NOTE:This application is specific to each group so you will not find it on the website.
...	Initial premium check payable to WHIT that matches the enrollment being submitted.

For all information regarding benefit levels, pricing or to request a quote, please contact Karni Adamson or Cricket Morgan at DiMartino Associates, Inc.
206-467-9408 (Seattle)
1-888-715-8000

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