Employee enrollment

Helpful resources on timing, qualifying events & more

Electronic Data Interchange (EDI) HIPAA Transaction – Benefit Enrollment and Maintenance (834)

Our Benefit Enrollment and Maintenance (834) companion guide (PDF) includes our specific requirements for the EDI transaction in addition to those found in the ASC X12N/005010X220 Implementation guide.  If you are interested in submitting your benefit enrollment and maintenance information electronically to Prevea360 Health Plan, download and complete the EDI Setup Form below. The EDI setup form below is a fillable PDF. Complete the EDI set up form by filling them out electronically and saving the file. Once completed, send the PDF as an attachment in an email to edi@prevea360.com.

EDI Transaction Number: 834

• View 834 companion guide (PDF)
• Open EDI setup form (PDF)
• Implementation guide information available through X12

Alternative to EDI requests and responses:

Our Employers Portal is available for those employer groups who choose not to submit benefit enrollment and maintenance using EDI.

Annual enrollment

For groups with more than 51 employees that offer dual choice or multiple health insurance carriers

It is your responsibility to ensure Prevea360 Health Plan has all health plan carriers offered on file. This is done by completing and returning the Group Information Form included in your annual enrollment materials. View sample Group Information Form.

Dual choice enrollment period is when an employee, already insured under another plan offered by your group, can change to Prevea360 Health Plan at the group’s anniversary date. We automatically allow a dual choice period each year for all employers with two or more health insurance carriers.

During the dual choice enrollment period, employees and their currently insured dependents can enroll in other plans offered by Prevea360 Health Plan. 

The employer determines the length of the dual choice enrollment period; however, the effective date of coverage will always be the group’s anniversary date. Applications must be received by us within 31 days of the anniversary date.

Example: If your anniversary date is Jan. 1, your enrollment period can be held in November or December. Any employee changing plans would be effective with Prevea360 Health Plan coverage as of Jan. 1, and the application would have to be received by Prevea360 Health Plan no later than Jan. 31. Midyear changes between plans are not allowed.

Enrollment guidelines

Employees who elect coverage must complete an Employee Application for Group Coverage Form. You can enroll new hires through our online portal. See the employee application for group coverage

Notify your Account Manager if staffing changes require updates in your portal access.

Timely enrollment

The form(s) must be signed by the employee and received by us no later than 31 days from the eligible employee’s effective date of coverage. If an application is not received within 31 days from the effective date, they will be considered a late enrollee, if late enrollees are allowed by the group.  Employers should review their Group Master Policy for late enrollment provisions.

Avoiding enrollment delays 

Be sure to complete the section at the top of the application labeled “For Employer Use Only” and review each application to make sure your employee completed all of the information before sending it to us.

Pay special attention to the following:

• Hire date
• Social Security number(s) - for each person applying for coverage
• Birth date(s) – for each person applying for coverage
• Primary care provider(s) election for each person applying for coverage (Not required for POS/PPO plans)
• Address
• Signature and date
• Group number
• Employee plan selection
• Reason for application
• Gender

If an application is not signed or dated – or if any of the above information is missing – we will request a completed application from the employer. This may delay the application unnecessarily. Pay close attention to this section before sending us any application.  

Waiver of coverage

If an employee chooses not to take coverage when it becomes available to them, employers should have the employee complete the Waiver of Coverage form and maintain that form in their files.

Government mandate to collect social security numbers 

Social Security numbers are now required in accordance with Section 111 of the Medicare, Medicaid and SCHIP Extension Act of 2007. Provisions for this are found under 42 U.S.C. 1395y(b)(7). We may contact you or the member/dependent directly to request the Social Security number.

If the number is not provided, we may delay or deny payment of medical claims for that specific member. Social Security numbers will only be used to report or to establish Medicare eligibility.

ID cards 

Once an application is completed, an employee is enrolled within five business days. An identification card is mailed to the employee’s home address seven to 10 business days from receipt of the application. If the application is missing information needed to enroll the member, the enrollment is delayed until we receive this information. All missing information required to enroll the member must be received within 31 days of the initial application. Temporary ID cards may be printed from the portal, but not until the enrollment is complete.

The “employee copy” or yellow copy of the group application form can used as a temporary ID card until he or she receives an ID card. If you print the form online, a photocopy of the form can also be used as a temporary ID card. The provider should make a copy of the form if they send the original to Prevea360 Health Plan.

If the provider used the portal, they should keep the original. The provider can also contact our Customer Care Center to verify the coverage date of the employee/dependent. If services are needed before receiving an ID card, have the member contact our Customer Care Center for assistance.

See Tips on Reading Your Member ID Card.