Enrollment/Eligibility FAQs:

Can I enroll in the insurance plan after the enrollment deadline?

You can enroll in our plan within 30 days of a qualifying event (loss of other coverage) regardless of our enrollment deadline. You must supply written proof that your other coverage has terminated through a qualifying event.

I have purchased coverage for myself. Can I also purchase coverage for a member of my immediate family (spouse, child, parent)?

Please consult your plan's enrollment information. Typically coverage is available.

What is COBRA?

Continued health insurance coverage for employees who have lost their health insurance coverage based on a qualifying event.

How long can I have COBRA coverage?

The length of time you can have COBRA for is based on the qualifying event. For example, COBRA coverage as a result of termination of employment is usually 18 months.

What is a "pre-existing condition"? How does this affect me as a consumer of health insurance?

A pre-existing condition is any condition for which you have had symptoms or services provided before the effective date on the plan. You must consult your Student Health & Accident brochure or Plan Document to see if there is a clause that limits the coverage of pre-existing conditions.

Claims FAQs:

How can I check the status of a claim I submitted?

You can login here and check the status of a claim that you have submitted.

What is my login?

If you are a Wellfleet member, you will create your own username and password when you first register for access. If you are a provider, group administrator or broker, please contact us for intital access.

What if I don't know what my password is?

If you are a Wellfleet member, you will create your own username and password when you first register for access. If you are a provider, group administrator or broker, please contact us for initial access. If you are registered, but forget your password, click here to re-set it. If you need additional assistance, please contact us.

What if my password doesn't work?

Passwords are case-sensitive. Please be sure you have entered it exactly as required. If you have forgetten your password, click here to re-set it. If you continue to have a problem, please contact us

What are some of the reasons Wellfleet might not reimburse my medical provider for a claim I submitted?

Other insurance may be responsible for paying the claim; the services may not be covered according to the exclusions listed in your brochure or Plan Document; the claim may not have occurred while you were covered; or the charges may be over Reasonable and Customary. A letter from Wellfleet will accompany any denial of claim indicating the reason for non-payment.

If I am in a car accident or other accident, what kind of documents will I need in order to submit a claim for reimbursement?

You will be asked for a description of the accident, other coverage information and perhaps a police report. Wellfleet will send a letter to you requesting the pertinent information.

What is a Reasonable and Customary charge and how does that charge affect me as a consumer?

Reasonable & Customary (R&C) charges are guidelines developed by an independent source and used by insurance companies to help assure that the fees providers are charging for services are reasonable for their geographic area. WellfleetInsurance utilizes the 80th percentile of R&C for most of our plans.

What if I have Cigna Dental Claims?

Please send CIGNA DENTAL CLAIMS to: Wellfleet Group, LLC, 2077 Roosevelt Avenue, Springfield, MA 01104.

PPO/Provider FAQs:

How can I access the online provider portal to view claim status, etc.?

If you have access to the Wellfleet online portal, click here to log in.

If you do not currently have log-in access and would like access, please contact Wellfleet Provider Relations at: provider_relations@wellfleetinsurance.com.

If you have questions on claim status, you may also contact us at (413) 733-4540, or toll-free at (800) 633-7867, and select option 2.

Who do I contact to verify a patient's eligibility and benefits?

To verify eligibility and benefits, members and providers can call Wellfleet at (413) 733-4540, or toll-free at (800) 633-7867, and select option 2.

Where do I submit my claims?

Providers should submit claims to the network address on the patient's ID Card.

For non-plan providers, claims should be submitted to Wellfleet Group, LLC (formerly CHP) at the address on the patient's ID card.

Note: Providers currently submitting paper claims who would like to be set up to submit claims electronically should contact their electronic claim vendor and they will work with Wellfleet IT to complete this set up. Wellfleet's electronic ID # is 87843.

Who do I contact to make a change to my provider demographic information?

If you have change to your name, address or phone number please email the changes to provider_relations@wellfleetinsurance.com. This will assure claims payments are submitted to the correct address.

When will I receive my 1099-Misc tax form?

Wellfleet sends 1099-Misc tax forms to providers who were issued claim payments. This form is mainly used for filing your tax return. Wellfleet typically mails 1099-Misc forms each year by the end of January.

Student Health Insurance FAQs:

How do I determine which network I am in to find an in-network provider?

To find a provider in the network used by your plan, locate the network logo found on your ID card, Student Health Brochure or Plan document. You can access your provider directory by clicking on the Provider Search link below or clicking on the PPO network link found on your individual group page. 

Look up providers by finding your network logo here.

When scheduling an appointment, should I tell the provider's office which network I have?

Yes. The office should look on your ID card to identify the network you have and to confirm they are participating in that network.

Do I need a password to print a claim form?

No, passwords are not required to print claim forms. You can obtain a claim form at the Homepage Quick Links or click here.

If I am working on my dissertation or thesis, but I am not enrolled in classes. Can I apply for insurance through Wellfleet?

You must consult your Student Health & Accident brochure. Generally the policies allow coverage only for those students who are enrolled full-time. 

What happens if I drop out of school while I am enrolled in your insurance plan? Will you refund my money? If not, am I still covered?

You will not receive a refund. However, your plan will continue through the period for which you paid.

If I have my own doctor in the community and I don't want to go to the campus health center for care, will Wellfleet consider my claim?

Since all our plans are different, you will need to consult your plan brochure. 

Does Wellfleet's student insurance cover dental or eye care?

Consult your Student Health & Accident brochure. Typically plans do not offer dental or vision coverage, only coverage for sickness or accidents to the teeth or eyes. Wellfleet offers a discount dental card program. Please visit here for details. If your plan does not have coverage for dental you can also purchase an individual plan by visiting here. Most of our plans include a discount vision program. To learn more about our vision discount program please visit here.

Do you have a glossary of terms?

Yes. Please view here.