New business submission guidelines

Health New England will require all new group submissions be received ideally, at least 5 days prior to the effective date.

The information required for new business submission
is as follows:

  • Signed Employer Group Application
  • All Member Enrollment forms completed in full and signed by the subscriber and employer
  • Most recent WR1/Quarterly Wage Statement or Payroll Records (or other appropriate documentation to verify group and subscriber eligibility).
  • Domestic Partner Rider form (if applicable)
  • Confirmation of the sold rates
  • Health Equity Forms (if applicable)

What is needed to get a self-funded quote from
Health New England:

  • Name of the business
  • Census of employees, including zip code
  • Effective/renewal date
  • A copy of the health plan documents from the present TPA describing current benefits.

These materials can be sent to

If you have any questions regarding the submission requirements, please contact your Health New England New Business Sales Executive at (413) 233-3535.

Health New England reserves the right to request any additional information necessary to verify employer and/or employee and/or dependent eligibility.