Welcome to Group Health Cooperative of South Central Wisconsin!                    

This spreadsheet template provides two format options to submit your initial new group employee enrollment data to our GHC-SCW Enrollment department to process. This spreadsheet template should only be used for new group enrollments, and is only offered if your organization cannot support 834 data loads or use GHC-SCW's online enrollment solutions.

The data in the spreadsheet will be loaded directly into the GHC-SCW Enrollment systems, apart from PCP Selections, which are reviewed and entered manually by our Enrollment staff.             

Important Details

Example data is provided for each method. Please delete all example lines before submitting.

Please see the Data Dictionary tab for acceptable formats for several key fields, such as dates, addresses etc. Required fields are highlighted in green and optional fields are highlighted in yellow.

If you have any questions about filling out the form, please reach out to your GHC-SCW Sales Representative for clarification.

How to Submit:

This template offers two methods of organizing your data. Please pick one method (By Employee or By Member), whichever is more convenient based on your data source.     

1. By Employee: Using this method, each Employee has their own line. If an Employee has multiple dependents, they'll all appear on the same line.  The sheet supports up to eight dependents.
   • In the By Employee Method, required fields for dependents only apply if there are dependents. Only fill out fields for the number of dependents needed for each employee. Any unneeded fields for additional dependents can be left blank.
2. By Member: Using this method, each Member has their own line. If an employee has three dependents, the spreadsheet will include four rows, one for the Employee and one for each dependent.
   • In the By Member Method, you'll need to repeat the employee information for each line to ensure employees and dependents are linked properly.

Download the By Member spreadsheet template here.

Download the By Employee spreadsheet template here.