WHIT New Group Setup - Brokers and Consultants of Healthcare Employees Health Care Benefits

NEW GROUP SETUP

Last Updated: September 10, 2009

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

	Zenith Susan McAdams Zenith Administrators, Inc. 201 Queen Anne Ave N Suite 100 Seattle. WA 98109
	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:

	WHIT Karni Adamson DiMartino Associates, Inc. 1301 5th Ave, Suite 3701 Seattle. WA 98101
	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 transmit 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.

WHIT Required Enrollment Information (all new applicants)
	WHIT Subscription Agreement
	New Broker Partners should also provide a copy of the Broker of Record.

Washington Dental Service (WDS) Required Enrollment Information
	Washington Dental Service Application
	Washington Dental Service Enrollment Form for all enrolled employees
	NOTE: 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.

Willamette Dental Group (WDG)Required Enrollment Information
	Willamette Dental Enrollment Form
	Initial premium check payable to WHIT that matches the enrollment being submitted.

Vision Service Plan (VSP) Required Enrollment Information
	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.

The Standard Required Enrollment Information
	Standard Master Application

Prudential Financial Required Enrollment Information
	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 at DiMartino Associates, Inc. 206-467-9408 (Seattle)
1-888-715-8000.