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

NEW GROUP SETUP

Last Updated: December 12, 2011

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

	Benefit Solutions, Inc. P.O.Box 6 Mukilteo, WA98275
	Victor Carter
	Phone:	206-859-2642
	Fax:	206-859-2637
	Email:	vcarter@bsitpa.com
	Kylie Fuller
	Phone:	206-859-2674
	Fax:	206-859-2637
	Email:	kfuller@bsitpa.com

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

	WHIT Karni Adamson DiMartino Associates 1501 Fourth Avenue, Suite 2400 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: Benefit Solutions 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
	Universal WHIT Enrollment Form
	NOTE: Benefit Solutions 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.

DENTAL-ODS ALASKA (for Alaska residents only)
	ODS Alaska Enrollment Form
	ODS Alaska Group Application
	ODS Declination of Coverage Form
	NOTE: Please contact Karni Adamson or Becky Wallen for groups with over 51+ lives.

Willamette Dental Group (WDG)Required Enrollment Information
	Universal WHIT 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

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