Dean Health Plan Employer Group Frequently Asked Questions

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Dean Health Plan Employer Group Frequently Asked Questions

How long does it take to enroll an employee and to issue identification cards once the application is received?

If the application is complete, the employee will be enrolled and an ID card mailed to the employee's address within two to three weeks from the time we receive the application. If the application is incomplete, enrollment will be delayed until we receive the necessary information.

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As an employer, what can I do to help avoid enrollment delays for my employees?

Try to review each application to see if it is complete before sending it to Dean Health Plan. Please pay special attention to the following areas:

  • Hire date(s)
  • Social security number(s)
  • Birth date(s)
  • Primary care provider(s) election (Not required for Point Plans)
  • Signature and date
  • Phone number

The phone number isn't required, but it is helpful since Dean Health Plan makes welcome calls to new members to explain benefits and answer any questions. Remember, applications that are not signed or dated will be returned to the employee. This may delay the application unnecessarily, so please double-check this section before sending applications to us.

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What happens if the employee does not receive his/her identification cards prior to the effective date of coverage?

The "yellow employee copy" of the Group Application Form may be used as a temporary identification card until he/she receives the ID card. Temporary ID cards are also available by logging in to DeanConnect. Providers can also call Dean Health Plan’s Customer Care Center to verify the coverage date of the employee/dependent.

Please note that the employee's social security number is used as the identification number for the employee and his/her dependents. Your employees should know this in case the provider asks for his/her member number to verify coverage.

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What is a Special Enrollment or Qualifying Event?

A special enrollment or qualifying event is an event that allows an employee to enroll in the insurance plan after having initially waived the coverage, or allows an employee to add a spouse or dependent(s) to his/her plan. Qualifying events are sometimes referred to as "life events" or "family status changes."

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Who is eligible to enroll when a "loss of other coverage" event occurs?

When a loss of other coverage occurs, only the employee and/or dependents who were covered by this other group plan immediately prior to the termination of the coverage are eligible to apply for coverage by Dean Health Plan. The employee may not add any dependents who were not previously covered under the prior health plan.

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When does coverage end for the employee?

You may terminate an employee's coverage with Dean Health Plan by:

  • Mailing or faxing a memo to the Enrollment Department with the employee's name, social security number and date of termination.
  • Making a note on the monthly billing statement.
  • Having the employee complete a Group Application Form and send it to our Enrollment Department. However, Dean Health Plan does not require this form to terminate an employee's coverage.

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Does Dean Health Plan allow retroactive terminations?

Dean Health Plan will refund or adjust premiums for retroactive terminations for up to three months. The month the request for retroactive termination is received is counted as one month.

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When should changes be received by Dean Health Plan to have them noted on the next billing statement?

We prepare bills at the end of the month before the mailing date, which is about the second week of the month prior to the coverage month. Therefore, for changes to be processed and noted on the next billing statement, they must be received by Dean Health Plan no later than the 20th of the month prior to the mailing date.

For example: if changes are received by February 20, they will be noted on the April bill, which is mailed approximately the second week of March.

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As an employer, how much do I need to know about group continuation?

As the employer, you are responsible for notifying your employees and their dependents in writing of their rights to COBRA and Wisconsin continuation coverage. Therefore, you must be familiar with which events are qualifying events for group continuation to be offered to an employee or dependent.

In addition, if your employee or dependent chooses to continue coverage, you need written documentation of their decision to continue. Therefore, you need to know the time guidelines that an employee has to elect group continuation.

Finally, you are responsible for collecting the monthly premium payments from the employee or dependent and then making payment to Dean Health Plan. Again, you will need to know the guidelines regarding when payments can be required from the employee or dependent and when a person can be terminated for nonpayment of premium.

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Whose responsibility is it to notify the employee or dependent when the group continuation coverage will end and their options after it ends?

Dean Health Plan will notify the employee/spouse/dependent by sending a letter several months prior to the end of their group continuation coverage. The letter states when the coverage will end and the options for purchasing conversion health insurance available to the employee/spouse/dependent through Dean Health Plan.

You can forward any questions regarding plan options after group continuation to the Dean Health Plan Customer Care Center.

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When are renewal rates prepared?

Sixty days before your anniversary date, you will receive your renewal package. For example, if your anniversary date is January 1, we will mail or deliver your renewal package by November 1. This package includes your renewal rates, benefit changes sheet and plan documents such as the Health Service Agreement, Member Certificate and Schedule of Benefits for your upcoming contract year.

If you need the renewal prior to the 60-day mailing date for budgeting purposes, please note this on the RRF or call your Account Manager.

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If, as an employer, we have questions concerning the Medicare eligibility of our employees, who should we contact?

Call the Dean Health Plan Medicare representative at (608) 827-4189, or toll free at (800) 356-7344, extension 4189. You may also be able to determine answers by contacting your Account Manager.

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What if I still have questions?

Dean Health Plan's Customer Care Center is available to answer your questions Monday through Thursday, from 7:30 a.m. to 5:00 p.m., and Friday, 8:00 a.m. to 4:30 p.m. Just call (800) 279-1301. If you prefer, you may also call your Account Manager.

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Prior Authorization FAQs

What is a prior authorization (PA) request?

A PA request is an extra step that is sometimes required before a member receives a specific service or procedure. A PA will not allow a service that is non-covered or a specific exclusion under the Member Certificate. For example, if cosmetic surgery is an exclusion of the policy, a PA will not change that benefit.

When and why is a PA needed?

Members can go to or log into DeanConnect to view their member certificate or contact the Dean Health Plan Customer Care Center to determine if the service or procedure requires a PA. For HMO members, typically anything out of plan requires PA.

Some specific services require PA so that Medical Affairs can review the medical necessity of these services. Seeking services with non-plan providers/out-of-network will usually require PA.

How does a member obtain a PA?

A member must obtain a written authorization letter from Dean Health Plan approving the requested service or procedure to give to their provider. It is the member’s responsibility to secure written authorization approval before receiving treatment to ensure proper handling of the claim.

My employee obtained a PA, why are they still being charged for the service?

Obtaining a PA does not mean that services will be covered at 100 percent; members are still responsible for normal copays/deductibles/coinsurance amounts for any authorized services.

When is a PA considered urgent?

Authorization requests are not considered urgent only because of scheduling needs, they must be medically urgent to be processed more quickly than the standard 14-day or less timeframe.

I received a clinical referral. Do I still need to process a PA with Dean Health Plan?

Yes. A clinical referral is different than an insurance authorization or referral. For example, an ENT doctor might require a referral from a family practice doctor to ensure patients are coming to them appropriately. If the ENT doctor is out-of-network, having a clinical referral to a specialist is not equivalent to an insurance authorization to receive those services.

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What will my Bill look like?

Cover sheet

The cover sheet will provide summary information including invoice date and billing period, a line item total of each of the group segments and grand total.

Billing detail

Following the cover sheet, you will find all group segment pages with detail listing each subscriber, tier and monthly premium amount.


Following the billing detail, you will find the deletions worksheet where any terminations can be noted.

Grace period

You have a grace period of 31 days from the due date of the bill to make the premium payment. Your group coverage will remain in effect during the grace period. You will receive a late payment notice from us, this is a standard notice mailed when premium payment is not made. The premium payment must be received by the end of the grace period or cancellation will occur.

Paying your premium invoice

Dean Health Plan offers you two options when paying your premium invoice.

  1. Payment by check upon receipt of your premium invoice which includes a reply envelope.
  2. Automatic Withdrawal (ACH) from your group's bank account.

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Billing FAQs

When can I expect my first Dean Health Plan invoice?

You will receive your first monthly Premium Billing Invoice on or around the 20th of the month of your group’s effective date.

What is included in the first invoice?

This invoice represents premium for your group’s first two months on the plan, and it will include a discrepancy report to reconcile your initial binder payment.

What happens if I make changes to my plan after submitting my binder payment?

Please note that any membership adjustments received on or after the 15th of the initial month of your coverage will not be reflected on your first monthly Premium Billing Invoice. These changes will be reconciled on the next month’s invoice.

What is the billing cycle after the first month’s invoice?

Regular monthly Premium Billing Invoices are prepared approximately 45 days in advance of their due date and are mailed on the 10th of the month prior to the due date. For example, invoices for October Premium are prepared at the end of August, mailed on Sept. 10, and due on Sept. 30.

Who can I contact with billing questions?

For questions about your Premium Billing Invoice, contact Dean Health Plan’s Enrollment & Billing Department at (800) 649-0258.

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