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Click on the links below for instructions and the answers to some frequently asked questions that we have received from employers. If you need further assistance please contact us. Download the complete Instruction Manual PDF version formatted for print Employee Administration Where should forms and questions be mailed to? Additions How do I enroll new employees? What is a late enrollment? Can a new employee waive coverage? Can an eligible employee enroll after initially waiving coverage? Does ELH issue ID cards? Changes What employee changes must I report to ELH? How do I make these types of changes? When should I notify ELH of a change? Does an employee need to enroll a new dependent if they already have dependent coverage? Can an employee continue coverage for a covered dependent who has reached the regular age limit on the plan? Terminations When does an employee’s or a dependent’s coverage terminate? When should I report the termination of an employee or a dependent? Should I notify ELH if an employee is disabled or on a leave of absence and is no longer working on a full-time basis? How do I notify ELH of the termination of an employee’s coverage? How do I notify an employee or dependent of conversion or COBRA continuation rights? What is a conversion privilege? How does an employee or dependent apply for Life conversion? What is COBRA? Which coverages does COBRA impact? How does an employee or dependent apply for COBRA? Employer Administration Does ELH issue Employee Certificate booklets? Where should forms and questions be mailed to? How do I notify ELH of a change in our company name or address? How do I request coverage for a new subsidiary? When do I notify ELH of a change? How do I make a plan design change or add to our group’s coverage? Does ELH provide information for Schedule A, Form 5500? How do I terminate one or all of our group’s coverages? Premium Billing Where should forms and questions be mailed to? When will I receive my premium statement? When should I make my premium statement payment? What happens if payment is not received by the due date? Can coverage(s) be reinstated if coverage has lapsed due to nonpayment of premium? An employee has terminated. Can the premium statement amount due be changed to reflect this termination? When will the premium statement reflect changes? How and where should premium payments be remitted? Should additional forms or information be included with the premium payment? Dental Claims Administration Where should forms and questions be mailed to? How can I help my employees with their Dental claims? What is a Pre-Treatment Estimate and why is it important? How should a Dental claim be filed? How will the eligible employee know what their dental plan has paid and what, if anything, is owed to the dentist? How does ELH determine where to send the Dental benefit check? Life Insurance Claims Administration Where should forms and questions be mailed to? How should a Life Insurance claim be filed? How are Life Insurance benefits paid? In addition to a death benefit, Life Insurance provides for continuation of coverage during total disability, how can such a claim be filed? Long Term Disability (LTD) Claims Administration Where should forms and questions be mailed to? How should an LTD claim be filed? When should an LTD claim be filed? When are LTD benefits paid? How are LTD benefits paid? Where are LTD benefit checks sent? Are LTD benefits taxable? How are taxes withheld / paid? How are LTD benefits paid and withheld taxes reported to me? Who prepares W-2 Forms for Third Party Sick Pay benefits? Short Term Disability (STD) Claims Administration Where should forms and questions be mailed to? How should an STD claim be filed? When should an STD claim be filed? When are STD benefits paid? How are STD benefits paid? Where are STD benefit checks sent? Are STD benefits taxable? How are taxes withheld / paid? How are STD benefits paid and withheld taxes reported to me? Who prepares W-2 Forms for Third Party Sick Pay benefits issued by Eastern Life & Health? Mailing Instructions Where should Premium Remittance be mailed to? Where should Administrative Forms dealing with Employees and Dependents, such as Enrollment Forms, Notice of Change Forms, Notice of Cancellation and Continuation Forms be mailed to? Where should Life Conversion Quote Request Forms be mailed to? Where should Administrative Forms dealing with the Employer, such as your address change be mailed to? Where should Dental Claims be mailed to? Where should Life & STD Claims be mailed to? Where should LTD Claims be mailed to? Employee Administration Q. Where should forms and questions be mailed to? A. Eastern Life and Health Insurance Company Group Administration Department PO Box 83149 Lancaster, PA 17608-3149 E-mail: groupadmin@elhins.com Phone: 800-233-0307 Fax: 717-481-7175 Return to top Additions Q. How do I enroll new employees? A. All new employees, who are eligible, must complete the appropriate enrollment form. Be sure all instructions are followed and all sections are completed. To be considered a timely enrollment, the enrollment form must be sent to us within 31 days of completing the waiting period. It is very important that you understand the difference between non-contributory coverage (100% employer paid premium) and contributory coverage (employee pays all or a portion of the premium). Failure to make a timely enrollment in non-contributory coverage will result in retroactive billing. Return to top Q. What is a late enrollment? A. An enrollment will be considered late if it is not made on a timely basis. Late enrollment applies only to contributory coverage (employee pays all or a portion of the premium). If your employees enroll more than 31 days after completing the waiting period, they will be required to submit evidence of insurability that must be approved by us before the coverage can become effective (for life and disability coverage) or will be subject to a late enrollment restriction (for dental coverage) as explained in the employee certificate. Return to top Q. Can a new employee waive coverage? A. Your new employee can waive contributory coverage (employee pays all or a portion of the premium). The enrollment form contains a section where they can waive coverage and provide the reason. However, employees generally cannot waive non-contributory coverage (100% employer paid premium). Non-Contributory coverage waivers may be permitted only under specific circumstances, please contact us for additional information. Return to top Q. Can an eligible employee enroll after initially waiving coverage? A. An eligible employee can enroll at any time by completing the appropriate enrollment form. Be sure all instructions are followed and all sections completed. Depending on the type of coverage, the eligible employee may be subject to late enrollment restrictions or individual underwriting. Return to top Q. Does ELH issue ID cards? A. ELH issues ID cards for Dental coverage. A Dental ID card will be provided for each eligible employee enrolled in Dental coverage (2 cards will be supplied if dependent coverage is selected). Dental ID cards will be mailed directly to you for distribution. Return to top Changes Q. What employee changes must I report to ELH? A. You must notify us in the event of the following changes: Employee Name; Employee Address; Employee Salary; Employee Class; Beneficiary; or Addition or deletion of a dependent if dependent coverage is provided Return to top Q. How do I make these types of changes? A. Complete the Employee Change Card Form U202. Be sure all sections are completed, including the reason for change, date of change and employee signature. Return to top Q. When should I notify ELH of a change? A. You should notify us immediately. Failure to do so could result in inaccurate billing information. And, if we are not notified within 31 days, a new employee or dependent may be subject to late enrollment restrictions or individual underwriting. Return to top Q. Does an employee need to enroll a new dependent if they already have dependent coverage? A. Even if other dependents are covered at the time of adoption or birth of a new dependent, an enrollment form must be completed for the new dependent. If the enrollment form is received after the 31 day eligibility period, the eligible dependent may be subject to late enrollment restrictions or individual underwriting. Return to top Q. Can an employee continue coverage for a covered dependent who has reached the regular age limit on the plan? A. A covered dependent's coverage may be continued beyond the regular age limit, if we receive written proof that the dependent is a full-time student at an accredited school; primarily dependent upon the employee for support and maintenance, unmarried, and under the dependent student age limit shown in the certificate. The best way to verify student status is to send us a letter from the school. The letter should contain the name of the student, the dates of the specific semester, and notation that the student is classified as a full-time student. We may also accept some other school notice, such as a class schedule providing it includes the information previously noted. We might require additional information if we cannot verify the student's status. Return to top Terminations Q.When does an employee’s or a dependent’s coverage terminate? A. Coverage for an employee or dependent who is no longer eligible for such coverage will terminate. This can occur for a number of reasons including, but not limited to: Termination of employment; Disability; Reduction in work hours; Retirement; or Dependents that no longer meet the definition of dependent. Refer to the certificate for details. Return to top Q.When should I report the termination of an employee or a dependent? A. You should notify us immediately. Failure to do so could result in inaccurate billing information. Return to top Q. Should I notify ELH if an employee is disabled or on a leave of absence and is no longer working on a full-time basis? A. Yes. It is important that you notify us when an employee is no longer working on a full-time basis due to disability or leave of absence. Coverage could be impacted by such disability or leave of absence. An employee may remain eligible for coverage while not actively at work due to injury, illness, disability or an approved leave of absence, provided the employer continues to make premium payments for a predetermined length of time. Refer to the certificate for specific time limits. Return to top Q. How do I notify ELH of the termination of an employee’s coverage? A. Complete a Notice of Cancellation Form U204. Depending upon the type of coverage, you must inform the terminated employee and dependent, if applicable, of any conversion privileges or COBRA continuation rights, if you are subject to such federal regulation. Return to top Q. How do I notify an employee or dependent of conversion or COBRA continuation rights? A. To notify an employee or dependent, complete the Notice of Conversion or Continuation Rights Form GA145. This form is not an application. The employee or dependent signature only acknowledges receipt of the notice. Return to top Q. What is a conversion privilege? A. A conversion privilege is a provision in Life coverage that permits an eligible employee or dependent to convert their group coverage to an individual insurance policy when such group coverage terminates for certain reasons. Refer to the certificate for details. Return to top Q. How does an employee or dependent apply for Life conversion? A. To obtain a Life conversion quote, complete and submit the Life Conversion Information Request Form to ReliaStar Life Insurance Company (their address is printed on the request form). ReliaStar Life will mail the employee a rate quotation and application material for individual coverage. Please note, you must complete the Employer portion of this form. Return to top Q. What is COBRA? A. Federal Law gives certain persons the right to continue benefits beyond the date that they might otherwise terminate. Generally, employers with 20 or more full and/or part time employees are subject to COBRA requirements. COBRA requires that the employer provide us with timely notification of this coverage extension. Return to top Q. Which coverages does COBRA impact? A. Dental coverage is impacted if you are subject to COBRA requirements. Return to top Q. How does an employee or dependent apply for COBRA? A. To apply for COBRA, complete the Request for Continuation of Group Benefits Form U206. The employer completes Part I. The continuing individual completes Part II. Part III is to be completed by the employer when continuation ends. Instructions are provided directly on the form. Return to top Employer Administration Q. Does ELH issue Employee Certificate booklets? A. ELH distributes certificates electronically (PDF file format) to you via email. The email will include the Master Policy and Employee Certificates for each eligible classification of employees. Return to top Q. Where should forms and questions be mailed to? A. Eastern Life and Health Insurance Company Underwriting Department PO Box 83149 Lancaster, PA 17608-3149 Phone: 800-233-0307 Fax: 717-481-7188 Return to top Q. How do I notify ELH of a change in our company name or address? A. Send us a letter that includes your new name and/or address, the effective date of the change and the reason for the change. Return to top Q. How do I request coverage for a new subsidiary? A. All such changes must be submitted in writing. Include the following: Name and address of the subsidiary. Nature of business for the subsidiary. Listing of the employees to be added as part of the company. The listing should include: name, gender, date of birth, salary information, occupation, and dependent status (if Dental coverage). The effective date of the addition. Reason for the addition. Our Underwriting Department will review your request and provide you with further instructions. Return to top Q. When do I notify ELH of a change? A. All changes must be submitted to us prior to the effective date of the change. Return to top Q. How do I make a plan design change or add to our group’s coverage? A. Contact your agent for details on how to change the plan design(s) or add to your group’s coverage(s). All such plan design changes can only be made on the anniversary date of the coverage. Return to top Q. Does ELH provide information for Schedule A, Form 5500? A. Yes. We will provide information to you if you are required to file a Form 5500 with the IRS. We do not complete the Form 5500; rather, we provide you with the data that will enable you (or your tax advisor) to complete the form. Return to top Q. How do I terminate one or all of our group’s coverages? A. A letter requesting termination of one or all coverage(s) should be mailed to the Premium Billing Department 30 days in advance of the requested termination date. Please note the coverage(s) and date to be terminated. An authorized representative should sign this request. Return to top Premium Billing Q. Where should questions be directed? A. Eastern Life and Health Insurance Company E-mail: billing@elhins.com Phone: 800-233-0307 Fax : 717-481-8226 Return to top Q. When will I receive my premium statement? A.Premium Statements are mailed approximately 15 days before the due date. Return to top Q. When should I make my premium statement payment? A. Pay the premium in full on or before the due date that is stated on the invoice. Payment should be received by the due date so that there is no impact on coverage(s). Return to top Q. What happens if payment is not received by the due date? A. Failure to pay premium by the due date could result in the termination of coverage(s). Even though there is a 31 day grace period during which time coverage remains in force, to avoid any problems or termination, premium should be paid in full by the due date. Return to top Q. Can coverage(s) be reinstated if coverage has lapsed due to nonpayment of premium? A. Coverage terminated for nonpayment of premium can be considered for reinstatement if certain qualifications are met. Qualifications include: All past due and current premiums must be paid in full. Reinstatement form completed. Pay the $150 reinstatement fee. No other reinstatements during the past 12 months. Reinstatement is subject to our approval. Return to top Q. An employee has terminated. Can the premium statement amount due be changed to reflect this termination? A. It is very important that corrections or changes NOT be made to the invoice. Changes will be reflected as they are processed. Return to top Q. When will the premium statement reflect changes? A. If employee/dependent changes are received and processed after our billing cycle (usually the 10th of each month), the change will not be reflected until the next billing cycle. If changes are not reflected within two (2) billing cycles, please call our Premium Billing Department. Return to top Q. How and where should premium payments be remitted? A. Forward premium payment and remittance receipt to our corporate lockbox using the envelope enclosed with the invoice. Acceptable forms of payment are check or money order. Write your Policy number on the check or money order and include the remittance receipt so that payment will be properly credited to your account. Automatic payment of premium is also available. Contact the Premium Billing Department for more details. Return to top Q. Should additional forms or information be included with the premium payment? A. No. Only the remittance receipt should be mailed with your payment. Mailing the correct forms to the appropriate department will ensure efficient and timely processing. Return to top Dental Claims Administration Q. Where should forms and questions be mailed to? A. Eastern Life and Health Insurance Company Dental Claims Department PO Box 83888 Lancaster, PA 17608-3888 Phone: 800-233-0307 Fax: 717-481-8284 E-mail: dentalclaims@elhins.com Return to top Q. How can I help my employees with their Dental claims? A. You can instruct your covered employees to remember 3 important points: They should read their certificate carefully. The more they understand their Dental coverage, the fewer questions will arise. They should take their Dental ID card to the dental office. Although the Dental ID card does not guarantee benefits, the dental office needs the information shown on the card. They should give the dentist a Dental Claim Form. Even though we will accept other dental claim forms, it’s best to use our Dental Claim Form. Return to top Q. What is a Pre-Treatment Estimate and why is it important? A. Whenever the dentist proposes to do nonemergency major services that will exceed $400 in charges, we recommend that the dentist submit a Pre-Treatment Estimate to us before starting treatment. We will process the Pre-Treatment Estimate and send a Pre-Treatment explanation of benefits (EOB) to the dentist. This will let the eligible employee or dependent and the dentist know what portion of the treatment will be covered and what the benefit amount could be. It’s a good way to determine out of pocket expenses before proceeding with treatment. Return to top Q. How should a Dental claim be filed? A. The Dental Claim Form ELH100 should be used. Just follow the instructions on the form. The dentist must complete the provider information area as well as detailed information about the dental treatment. The mailing address can be found on the form and on the back of the Dental ID card. Return to top Q. How will the eligible employee know what their dental plan has paid and what, if anything, is owed to the dentist? A. They will receive an EOB for every claim that is processed. This EOB lists the submitted charges, indicates how much was covered or not covered, and tells them what their responsibility will be. If their dentist received the Dental benefit check, the dentist will also receive a copy of the EOB. Return to top Q. How does ELH determine where to send the Dental benefit check? A. The Dental Claim Form contains a line authorizing a release of information pertaining to the claim and a line authorizing us to send the benefit check to the dentist. If authorized, we will send the benefit payment directly to the dentist. If not authorized, the benefit check will be sent directly to the employee. Return to top Life Insurance Claims Administration Q. Where should forms and questions be mailed to? A. Eastern Life and Health Insurance Company Life and Disability Claims Department PO Box 83149 Lancaster, PA 7608-3149 Phone: 800-233-0307 Fax: 717-481-8252 E-mail: disabilityclaims@elhins.com Return to top Q. How should a Life Insurance claim be filed? A. You can contact our Life Claims Department by calling 800-233-0307 or emailing disabilityclaims@elhins.com. We will provide step-by-step assistance during this very trying event. If you or the beneficiary are unable to call, a Life Claim Form GB23 can be completed and sent directly to the Life Claims Department. Follow the instructions on the form. Return to top Q. How are Life Insurance benefits paid? A. Life Insurance and Accidental Death and Dismemberment proceeds are paid by check directly to the beneficiary with an accompanying explanation of benefits (EOB). Return to top Q. In addition to a death benefit, Life Insurance provides for continuation of coverage during total disability, how can such a claim be filed? A. A covered employee who becomes totally disabled before age 60 and whose total disability continues for 9 consecutive months can file for continuation of coverage. A Continuation of Coverage Claim Form GB157 must be submitted to us within 9 to 12 months after the disability begins. If you also have STD and/or LTD coverage with us, the employee does not need to file a separate continuation of coverage claim form. Return to top Long Term Disability (LTD) Claims Administration Q. Where should forms and questions be mailed to? A. Disability RMS One Riverfront Plaza Westbrook, ME 04092 Phone: 877-254-0085 Fax: 207-591-3048 Return to top Q. How should an LTD claim be filed? A. Contact the claims department at Disability RMS, the administrator for our long term disability benefits at 877-254-0085. They will send you the necessary LTD claim forms with all the instructions. If you have STD coverage with Eastern Life & Health, the employee does not need to file a separate LTD claim form. Return to top Q. When should an LTD claim be filed? A. An LTD claim should be filed as soon as you are aware that your employee's disability may continue beyond the maximum benefit duration limit of your short term disability coverage or salary continuation / sick leave program or the LTD elimination period. You should report the claim to Disability RMS at least 45 days prior to the end of the LTD Elimination period. Return to top Q. When are LTD benefits paid? A. LTD benefits begin after completion of the first full month of total disability following satisfaction of the LTD Elimination period. LTD benefits are paid monthly. Return to top Q. How are LTD benefits paid? A. LTD benefit payments are made by check. Each LTD benefit check will provide an explanation of benefits (EOB) statement that lists the gross benefit amount payable, taxes withheld, net benefit paid and payment period. Return to top Q. Where are LTD benefit checks sent? A. LTD benefit payments are usually mailed directly to the disabled employee at the address we have on file. Return to top Q. Are LTD benefits taxable? A. LTD benefits are taxable in direct proportion to your contribution to the premium payments. For example, if you pay all of the premium payment, the benefit is 100% taxable. If you pay half of the premium payment, the benefit is 50% taxable. Return to top Q. How are taxes withheld / paid? A.The employee's portion of Social Security and Medicare taxes are withheld from LTD benefit payments and deposited by Disability RMS in accordance with applicable tax laws. LTD benefits are taxable for Social Security and Medicare, subject to annual taxable income ceilings, on all LTD benefits paid during the first full 6 months following the end of the month in which the disability begins. You must report and deposit your (the employer's) tax responsibility for Social Security and Medicare taxes. Federal tax withholding is optional and taxes are only withheld when the employee specifically requests the withholding on the claim form. We do not withhold state or local taxes. Return to top Q. How are LTD benefits paid and withheld taxes reported to me? A. You will receive periodic Third Party Sick Pay Reports. These reports are prepared and sent in accordance with applicable tax laws. Reports are sent semi-monthly, quarterly and annually. Return to top Q. Who prepares W-2 Forms for Third Party Sick Pay benefits? A. It is the responsibility of the employer to produce all applicable tax filing forms. Disability RMS will prepare W-2 Forms when requested and authorized by the employer. Return to top Short Term Disability (STD) Claims Administration Q. Where should forms and questions be mailed to? A. Eastern Life and Health Insurance Company Life and Disability Claims Department PO Box 83149 Lancaster, PA 17608-3149 Phone: 800-233-0307 Fax: 717-481-8252 E-mail: disabilityclaims@elhins.com Return to top Q. How should an STD claim be filed? A. Contact our Disability Claims Department by calling 800-233-0307 or e-mailing disabilityclaims@elhins.com to report the claim. Or, you can submit a claim using ELH STD Claim Form GB119. Just follow the instructions on the form. Return to top Q. When should an STD claim be filed? A. An STD claim should be filed as soon as you are aware that your employee is disabled. Effective claims administration requires early claim reporting. To ensure prompt claim reporting and intervention by our claim management team, a copy of the completed employer/employee section of the STD Claim Form should be faxed to us at 717-481-8252 within 48 hours of your receipt of the initial notice of an STD claim. Return to top Q. When are STD benefits paid? A. STD benefits begin after completion of the first full week of total disability following satisfaction of the STD elimination period. STD benefits are paid weekly. Return to top Q. How are STD benefits paid? A. STD benefit payments are made by check. Each STD benefit check will provide an explanation of benefits (EOB) statement that lists the gross benefit amount payable, taxes withheld, net benefit paid and payment period. Return to top Q. Where are STD benefit checks sent? A. STD benefit payments are usually mailed directly to the disabled employee at the address we have on file. Return to top Q. Are STD benefits taxable? A. STD benefits are taxable in direct proportion to your contribution to the premium payments. For example, if you pay all of the premium payment, the benefit is 100% taxable. If you pay half of the premium payment, the benefit is 50% taxable. Return to top Q. How are taxes withheld / paid? A. The employee’s portion of Social Security and Medicare taxes are withheld from STD benefit payments and deposited by us in accordance with applicable tax laws. STD benefits are taxable for Social Security and Medicare, subject to annual taxable income ceilings, on all STD benefits paid during the first full 6 months following the end of the month in which the disability begins. You must report and deposit your (the employer’s) tax responsibility for Social Security and Medicare taxes. Federal tax withholding is optional and taxes are only withheld when the employee specifically requests the withholding on the claim form. We do not withhold state or local taxes. Return to top Q. How are STD benefits paid and withheld taxes reported to me? A. You will receive periodic Third Party Sick Pay Reports. These reports are prepared and sent in accordance with applicable tax laws. Reports are sent semi-monthly, quarterly and annually. Return to top Q. Who prepares W-2 Forms for Third Party Sick Pay benefits issued by Eastern Life & Health? A. It is the responsibility of the employer to produce all applicable tax filing forms. ELH will prepare W-2 Forms when requested and authorized by the employer. Contact the Life and Disability Claims Department to make arrangements. Return to top Mailing Instructions Q. Where should Premium Remittance be mailed to? A. The premium remittance should be returned with the invoice remittance coupon to: Eastern Life and Health Insurance Company PO Box 68 East Petersburg, PA 17520-0068 Return to top Q. Where should Administrative Forms dealing with Employees and Dependents, such as Enrollment Forms, Notice of Change Forms, Notice of Cancellation and Continuation Forms be mailed to? A. Eastern Life and Health Insurance Company Group Administration Department PO Box 83149 Lancaster, PA 17608-3149 Return to top Q. Where should Life Conversion Quote Request Forms be mailed to? A. ReliaStar Life Insurance Company Group Conversions, Route 6999 Box 20 Minneapolis, MN 55440-0020 Return to top Q. Where should Administrative Forms dealing with the Employer, such as your address change be mailed to? A. Eastern Life and Health Insurance Company Underwriting Department PO Box 83149 Lancaster, PA 17608-3149 Return to top Q. Where should Dental Claims be mailed to? A. Eastern Life and Health Insurance Company Dental Claims Department PO Box 83888 Lancaster, PA 17608-3888 Return to top Q. Where should Life & STD Claims be mailed to? A. Eastern Life and Health Insurance Company Life and Disability Claim Department PO Box 83149 Lancaster, PA 17608-3149 Return to top Q. Where should LTD Claims be mailed to? A. Disability RMS One Riverfront Plaza Westbrook, ME 04092 Phone: 877-254-0085 Fax: 207-591-3048 Return to top

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