Worksome Payroll Services Inc. offers eligible employees access to medical, dental, and vision coverage to support your health and well-being.
Your eligibility depends on your employment status.
Who Is Eligible?
You are eligible to enroll in health benefits if you are:
A full-time employee, or
A salaried employee
Part-time employees are not currently eligible for health insurance benefits.
If you would like to become eligible for benefits and are not currently enrolled, you must email us-payroll@worksome.com to formally request benefits enrollment. Your request will be reviewed and you will be added to the waiting period if eligible.
Your waiting period begins on the date you become eligible under Worksome’s policies. Coverage becomes available on the 1st of the month, on or following 30 days after hire.
Medical Insurance
Anthem Gold Blue Access EPO (HSA-Compatible Plan)
Medical coverage is provided through Anthem BlueCross BlueShield.This is an EPO (Exclusive Provider Organization) plan, which means you must use in-network providers to receive coverage (except in emergencies).
Key Plan Highlights for 2026:
Individual Deductible: $1,800
Family Deductible: $3,600
Out-of-Pocket Maximum:
$6,100 (individual)
$12,200 (family)
Office Visits
Primary care visit: $20 copay
Specialist visit: $50 copay
Preventive Care
Preventive services (such as annual physicals and certain screenings) are covered before you meet your deductible.
Emergency Services
Emergency room services are covered at 15% coinsurance (in-network level applied in emergencies).
Prescription Drugs
Prescription coverage follows a tiered structure:
Generic medications typically have lower copays.
Brand-name medications may require coinsurance.
You can view detailed pharmacy information through Anthem’s member portal once enrolled.
Employer Contribution
Your employer contributes 50% of the employee-only medical premium.
If you choose to enroll dependents, you are responsible for the full cost of dependent coverage.
Health Savings Account (HSA)
This medical plan is HSA-compatible, meaning you may be eligible to open and contribute to a Health Savings Account.
An HSA allows you to:
Contribute pre-tax dollars
Use funds for qualified medical expenses
Roll over unused funds year to year
Eligibility rules for HSAs are set by federal guidelines.
Dental Insurance
Guardian DentalGuard Preferred (PPO)
Dental coverage is offered through Guardian. This is a PPO plan, meaning you will save the most when using in-network providers, but you may visit out-of-network dentists.
What the Plan Covers
Preventive Care (100% covered)
Cleanings
Exams
X-rays
Basic Services (80% covered)
Fillings
Root canals
Extractions
Major Services (50% covered)
Crowns
Bridges
Implants
Orthodontia (50% covered)
Child orthodontia included
Annual Maximum
$3,000 annual benefit maximum
Includes a Maximum Rollover feature, which may allow unused benefit amounts to roll into future years (subject to plan rules).
Employer Contribution
There is no employer contribution for dental coverage. If you enroll, you are responsible for the full premium.
Vision Insurance
Guardian Vision (VSP Network)
Vision coverage is offered through Guardian with access to the VSP Signature Network.
Plan Highlights
Employer Contribution
There is no employer contribution for vision coverage. If you enroll, you are responsible for the full premium.
Cost Overview
**Costs may change depending on the selected plan and the number of children in the family.
Coverage Type | Employer Contribution |
Medical (Employee Only) | 50% |
Medical (Dependents) | 0% |
Dental | 0% |
Vision | 0% |
How to Enroll
Once you are eligible, you will receive access to enroll through Gusto, our benefits platform.
Through Gusto, you can:
Review detailed plan information
Compare coverage options
See your premium costs
Add eligible dependents
Complete enrollment
Enrollment must be completed within your designated enrollment window. You cannot make changes outside of open enrollment unless you experience a qualifying life event, like marriage, birth of a child, or loss of other coverage. If you do not make changes during open enrollment, your current coverage renews as-is.
If you’re not currently enrolled, and you have not chosen benefits during your enrollment window, you’ll stay unenrolled.
If you no longer want coverage, you still need to sign in and waive your benefits. Opting out of coverage is also known as waiving. If you do not want your company’s coverage, you need to sign a waiver in Gusto. Insurance carriers track why people waive coverage. They call these waiver reasons.
Choose carefully. You can only change your coverage if you’re newly eligible, during open enrollment, or when you have a qualifying life event.
Before you can enroll in benefits, you need to complete and sign your Form W-4 in Gusto. This makes sure we withhold the right amount from your pay.
To enroll in benefits coverage:
Step 1: Get started: Gusto will email you when it’s time to enroll.
Go to Benefits.
If you’re an admin, make sure you’re in your employee profile.
If you do not see this in your left menu, you may not yet be eligible for benefits. Contact us-payroll@worksome.com for next steps.
In the tile at the top of your Benefits page, check your selection deadline, then click either Enroll or Waive.
Click Get Started!.
You may be asked what matters most to you in a health plan and who you'd like to cover. This is used to recommend plans.
Step 2: Verify your information
Verify your info for the insurance carrier’s records and enter your dependents’ information. If you’re waiving coverage, you’ll do so on the next page.
Verify your personal info.
If anything is incorrect, reach out to us-payroll@worksome.com to make changes.
To review dependents, scroll to Your dependents.
You’ll see all dependents here, whether or not you’re enrolling them. You’ll enroll or remove them from benefits on the next page.
If any dependents have aged out of eligibility for coverage, you’ll see them under a section called Ineligible for coverage.
To add a dependent to the Your dependents list:
Find the Add a new dependent tile and click Add dependent.
Enter their personal information and click Save.
To add more dependents, click Add dependent again.
To remove a dependent from your list of dependents:
Click Edit.
Click Remove. (If this does not work, go to the next page, where you can remove the dependent from coverage.)
Click Save & continue.
The next page lists each type of benefit that Worksome offers. When you click Enroll or Waive, you’ll see the plan options and pricing for each benefit.
Step 3: Choose or waive medical coverage
On the Medical tile, click either Enroll or Waive.
If you do not want to enroll, scroll to Waive Medical Coverage and click Waive.
Select the dependents you’re enrolling in this plan.
Check the box next to each dependent you’re enrolling.
Click the box again to uncheck it and exclude that dependent from this plan.
Review all the plans and consider which benefits and premiums fit your needs for the next year.
Need help choosing? Watch this video about plan types and insurance terms.
Cost: “Your cost” shows how much comes out of each paycheck. Hover over the "i" icon to see the total monthly premium and your company’s contribution.
Coverage: Click View full plan details to review each plan’s Summary of Benefits. This shows what you’d pay for common services.
Click Select on the plan you decide on.
Click Save & continue.
Step 4: Choose or waive the remaining lines of coverage
Next, for vision and dental, click Enroll or Waive and repeat the above steps for each.
Step 5: Review your selections and understand the cost summary
Once you’ve enrolled in or waived each line of coverage, check that each line of coverage reflects your choices.
Click View Enrollees for each benefit to see who you’re enrolling in the plan.
Review the cost summary.
Total Cost of Benefits: The total premiums per pay period for each line of coverage you selected and each dependent you enrolled (if any).
Employer’s Contribution: The portion of the total cost that your company is paying for you each pay period.
Your total cost: The amount that comes out of each of your paychecks. Payroll is processed weekly, and the premium shown will be processed weekly as well.
Click Save & continue.
Step 6: Add waiver reasons and extra info
If you’re waiving coverage: The insurance carrier asks for the reason to make sure your company meets their participation rules. Check out the Waive benefits coverage section of the article for more info.
Answer the questions on the Add Extra Information page.
Click Save & continue.
Step 7: Review and confirm your selections
Review each line of coverage. Make sure your plan choices and dependent enrollments are correct.
To make changes, scroll to the bottom of the page and click Back.
Scroll to Forms you need to sign.
Click Sign form beside each form.
To review a form, click on its name to open it in a new tab.
Draw your name in the signature field and check the box where it says “I agree to electronically sign this form.”
Click Sign.
Once you’ve signed each form, click Confirm selections.
What comes next
Submission to the carrier:
The completed paperwork and your selections will be sent to the health insurance carrier.
Enrollment status: You can view the status of your enrollment from the sticky note on your Benefits page.
Member ID and accessing care: Once the carrier processes your coverage, they’ll mail you your member ID card.
Here are ways to find your member ID:
Check your mailbox: Most health insurance carriers mail ID cards to your home in an unmarked white envelope within a few weeks of your coverage effective date. If you're enrolled in a Health Savings Account (HSA), Health Flexible Spending Account (FSA), or commuter benefits with Gusto, we email you when your card ships. It'll arrive in 7–10 business days.
Look in Gusto: When Gusto is your broker and the carrier shares your group or member ID with us, we store these numbers for you. Follow the steps below to find them under Benefits in your employee account.
Ask your insurance carrier: Sign in to your carrier's member portal or call their member services line. They can also send you another copy of your physical ID card.
Try your Social Security number: Dental and vision carriers often use the primary insurance holder's Social Security number as your member ID.
Find your health insurance group and member IDs in Gusto
You can always find your Gusto Health FSA, HSA, Dependent Care FSA (DCFSA), and commuter benefits IDs in your employee account. We also store insurance ID numbers in your account when carriers provide them to us.
Go to Benefits.
Click on the account or benefit type that you need your ID for.
If your enrollment is still processing and you need care, see below.
If your carrier provided us your group or member ID, you can find it in Benefit Overview.
If you need care before your ID card arrives, your doctor or pharmacy can use your member ID and group number to confirm your coverage. You can also contact the carrier directly. Many carriers provide electronic options on their website.
If you need care before your ID card arrives, your doctor or pharmacy can use your member ID and group number to confirm your coverage. You can also contact the carrier directly. Many carriers provide electronic options on their website.
Insurance carriers often finish processing coverage after the effective date passes. When approved, coverage still starts retroactively from the effective date. If your coverage is still being processed after your effective date, you may need to pay out of pocket for covered services. You can then submit a claim for reimbursement once your coverage is confirmed.
Follow these steps if you need care but have not received an ID number:
Call your insurance carrier to confirm your enrollment status and coverage effective date.
Confirm your health provider is in-network with the new insurance carrier.
Google your carrier’s “provider search tool” to search by provider name or facility.
Seek care when you need it and save your payment receipts. You may need to pay out of pocket for now or ask your providers to delay billing.
Once the carrier confirms your member ID:
If you have not paid your provider yet, ask them to re-bill you for services through your new insurance.
If you paid out of pocket, file a claim with the carrier for reimbursement of covered services. Contact your carrier for information about their claims process.
ID cards for renewing benefits
Here’s what to remember as your new plan year begins after open enrollment.
If you already had coverage and chose the same carrier and plan network during open enrollment:
Your existing ID card should still work.
Review your new Summary of Benefits in Gusto. Carriers may change coverage even when you keep the same plan. Call your carrier with questions about what your plan covers.
Check whether your deductible resets on the calendar year or the plan year. Sign in to your carrier's portal or call them if you're not sure when it resets.
If you switched plans or carriers:
Your renewal effective date determines which plan covers you. Find your coverage effective dates in Gusto under Benefits.
If you need to go to the doctor before your renewal effective date, use your existing plan’s network and coverage.
If you visit the doctor after your new plan’s effective date, use the new plan’s network and coverage, even if you have not received a new ID card yet. See above for next steps if you need to go to the doctor before your new ID card arrives.
Benefits enrollment deadlines
If you’re a benefits-eligible employee, here's how much time you have to choose plans in Gusto, depending on your enrollment window.
New Eligibility enrollment
You have until 20 days after the coverage effective date to enroll.
Example: If you were eligible on January 3, your benefits would start on March 1st. You’d have until March 20th to enroll.
Open enrollment
You’ll typically have about a week to choose your coverage.
If you need to change your enrollment selections, you can do so in your Gusto account through the last day of open enrollment.
Qualifying life event
Outside of new hire or open enrollment, you can only change your coverage if you have a qualifying life event (such as the birth of a child or getting married).
You must submit your qualifying life event within 30 days of the event.
Need Help?
If you have questions about:
Eligibility or enrollment access:
📧 us-payroll@worksome.com
Plan details or coverage questions:
📧 benefits@gusto.com