“Got my daughter’s bill knocked down from $800 to a $30 co-pay! I love Reclaim! ”
Dena, Reclaim user
Optimizing every dollar spent on healthcare with AI.
https://www.wtwco.com/en-us/insights/2024/11/soaring-healthcare-costs-spark-us-employers-urgent-mission-cut-costs-and-boost-affordability
Despite your best efforts, healthcare remains largely unaffordable.
The unrealized value of your benefits is hindering your healthcare affordability initiatives.
Unexpected.
Received erroneous bills2
45%
74%
forfeited.
Forfeited FSA funds3
47%
of families struggle to afford healthcare1
unrealized.
Missed filing for eligible voluntary benefits4
90%
References: [1] 2024 KFF survey, [2] 2024 The Commonwealth Fund, [3] 2024 EBRI, [4] 2019 SHRM
confidential & proprietary
https://www.voya.com/news/2021/03/voya-financial-introduces-new-claims-model-to-help-american-workers-maximize-their
https://www.voya.com/news/2021/03/voya-financial-introduces-new-claims-model-to-help-american-workers-maximize-their
https://www.ebri.org/content/new-analysis-of-3.2-million-flexible-spending-accounts-finds-average-contributions-increasing-while-half-forfeiting-funds-to-their-employers
Optimizing every dollar spent on healthcare.
confidential & proprietary
Optimizing benefits to healthcare dollars for employers and their employees.
it all starts with detailed claims data
analytics insights and Simulation
AI-POWERED proactive bill savings
personalized benefit optimization
Past and ongoing medical & Rx for covered employees and dependents.
Real-time reporting of overcharges, recovered dollars, and member engagement. Simulate benefit plan changes.
100% claims reviewed for accuracy, with proactive recovery of overcharges, and owed benefits.
Year-round utilization and expense prediction and benefit recommendation in context of bill review.
confidential & proprietary
Powered by claims data & world-class AI.
100
claims reviewed 24/7/365 powered by AI with scalability
"Having actual claims data makes it do its magic! Employees appreciate the valuable insight and guidance it provides."
"Thank you for your thorough review! I had no clue I could get this reimbursed. Very much appreciated!!"
79
Dir. Total Rewards
Sr. Logistics Mngr
Financial Services
Mfg. Company
activations enabling recovery without employee action.
confidential & proprietary
budgeting
Claims
bill savings
Personalized. Powered by claims data.
Comprehensive, line by line medical and Rx claims for all covered lives. Claims access through our existing data use agreements with TPAs nationwide or employer's data warehouse.
confidential & proprietary
budgeting
Claims
bill savings
Proactive claims review and resolution.
Proprietary algorithms highlighting:
- claim inaccuracies issues,
- owed patient credits,
- voluntary benefits, and
- ancillary programs.
confidential & proprietary
budgeting
Claims
bill savings
Proactive claims review and resolution.
Proprietary algorithms highlighting:
- claim inaccuracies issues,
- owed patient credits,
- voluntary benefits, and
- ancillary programs.
"Thank you for your thorough review! I had no idea I could get this corrected. Very much appreciated!!"
Sr. Logistics Manager
Mfg. Company
confidential & proprietary
https://ttlc.intuit.com/community/tax-credits-deductions/discussion/if-i-receive-a-refund-from-a-medical-provider-paid-through-an-hsa-account-is-it-necessary-to-deposit/00/46839
https://www.reddit.com/r/personalfinance/comments/1hppdnh/refund_to_fsa_card_not_hitting_until_2025_what/
"Thank you for ensuring I was not double billed!"
background
An employee had a diagnostic colonoscopy that turned into a treatment colonoscopy with polyp removal. The employee (and employer) were billed for both services, when the treatment colonoscopy should have only been billed.
employeE saved
AI detects coding Error
reclaim requests bill review
provider re- submits claim
TPA processes employer credit
WE reconcile patient credit
$1K
AI alerts Reclaim advocates of bill error & detailed course of action. Opportunity shared with employer & employee.
We contact provider requesting bill review & ensuring bill collection is paused. Status shared with employer & employee.
Formal claim re-submission allows noting credits for both employer & employee. Status shared with employer & employee.
TPA adjusts claim(s) & issues employer credits. Reclaim monitors claim adjustment and credits in next claims feed.
We request provider reimburse patient. When applicable, we coordinate with member to process HSA mistaken distribution.
employeR saved
$4K
confidential & proprietary
Reversed patient overpayments
Correcting miscoding, duplicate claims, etc.
FSA, voluntary reimbursements
Employee spotlight
Employee spotlight
"Thank you for reviewing my current medical plan spending and recommending I change plans because I am overpaying! Very helpful!"
First name
Role and perhaps context as to how much she got in payouts.
"I had no clue I am owed money. Thank you very much for helping me get reimbursed! Very much appreciated!"
"I had no clue I am owed money. Thank you very much for helping me get reimbursed! Very much appreciated!"
First name
First name
First name
Role and perhaps context as to how much she got in payouts.
Role and perhaps context as to how much she got in payouts.
Role and perhaps context as to how much she got in payouts.
"I had no clue I could get this reimbursed!"
background
Matt had a sports injury that left him with several fractured bones that had him skip weeks from work. Matt forgot he had enrolled in an accident plan and had been auto-renewing it. Reclaim detected he is eligible for a voluntary benefit (VB) payout and proactively filed and secured the payment on his behalf.
VB issues reimbursement
employee saved
reclaim monitors status
reclaim detects VB opportunity
reclaim initiates Filing
Check mailed to employee with final payout confirmed.
Status updates, incl. follow up on addt'l documentation.
Upon claims data receipt, AI triggers accident payout.
Automated filing for preferred voluntary benefit partners.
$18K
confidential & proprietary
Reversed patient overpayments
Correcting miscoding, duplicate claims, etc.
FSA, voluntary reimbursements
Employee spotlight
Employee spotlight
"Thank you for reviewing my current medical plan spending and recommending I change plans because I am overpaying! Very helpful!"
First name
Role and perhaps context as to how much she got in payouts.
"I had no clue I am owed money. Thank you very much for helping me get reimbursed! Very much appreciated!"
"I had no clue I am owed money. Thank you very much for helping me get reimbursed! Very much appreciated!"
First name
First name
First name
Role and perhaps context as to how much she got in payouts.
Role and perhaps context as to how much she got in payouts.
Role and perhaps context as to how much she got in payouts.
budgeting
Claims
bill savings
Optimized benefits and budgeting.
Collaborative filtering yielding time-based utilization predictions. Out of pocket prediction & pre-tax contribution optimization.
"Having actual claims data makes it do its magic! Employees appreciate the valuable insight and guidance it provides."
Director, Total Rewards
Financial Services Company
confidential & proprietary
Reclaiming healthcare dollars.
Employer & employees
Employees
Billing corrections
Reimbursed benefits
Per 10K covered families
$6.3M
~ 3.5% of total medical spend across our BoB
Employer & employees
Employer
HSA/FSA tax benefits
Medicare transitions
real dollars back in employer's budget and their employees' pockets
confidential & proprietary
CONFIDENTIAL AND PROPRIETARY
Annual Potential Financial Opportunity
Overbilling correction
Return distribution
$99K
VB Payout*
Potential return
Employer
$150K
$300K/Year
~40%
HSA/FSA Contribution
$51K
Tax savings
Employee
Medicare Transitions
~60%
$0
Page 9
Traditional PEPM Pricing Proposal
Proposed pricing based on a 3-year agreement.
confidential & proprietary
Potential return on investment.
*Based on population based assumptions and optimal deployment.
confidential & proprietary
Optimizing every dollar your healthcare benefits have to offer.
Optimized benefits
Payment advocacy
Analytics & reporting
- Claims-driven year-round benefit recommendations
- Overcharge detection reports affecting employer and employees
- Proactive review of 100% of all bills, from the smallest to largest
- Real-time reports on dollars reclaimed and member engagement
- Proactive overcharge detection: upcoding, duplicate/wrong billing, & unbundling
- Medical plan and voluntary benefit recommendation at open enrollment
- Claims-driven benefit fit across member cohorts
- Year-round out-of-pocket spend prediction & budgeting
- Proactive voluntary benefit & FSA/HSAreimbursement detection
- Benefit fit analysis accounting for reclaimed dollars
- Year-round engagement in healthcare benefits programs in context of claims
- Proactive recovery of all owed dollars by dedicated human advocates
confidential & proprietary
Integrated with your ecosystem and optimized rollout to maximize savings.
03
02
04
01
Rollout
Benefits
Delivery
Claims
Opt in model by partnering with benefit admin to collect consents at enrollment. When presented at the time of benefits selection, an average of 79% activate in year 1.
Benefit design details captured in partnership with employer and their consultant(s). Enrollment & eligibility captured via backend integrations with employer's benefit admin.
Member-facing app (web and mobile), standalone or embedded in employer's benefit app. Analytics dashboard with real-time access to insights, savings reports, with role-based access,
Established data use agreements with national carriers & a growing number of regional TPAs.
confidential & proprietary
Employee spotlight
Employee spotlight
"Thank you for reviewing my current medical plan spending and recommending I change plans because I am overpaying! Very helpful!"
First name
Role and perhaps context as to how much she got in payouts.
"I had no clue I am owed money. Thank you very much for helping me get reimbursed! Very much appreciated!"
"I had no clue I am owed money. Thank you very much for helping me get reimbursed! Very much appreciated!"
First name
First name
First name
Role and perhaps context as to how much she got in payouts.
Role and perhaps context as to how much she got in payouts.
Role and perhaps context as to how much she got in payouts.
power giving to us by the employer group plan. Bounded by TPO - HIPAA permits it in that regard. implicit that member is on notice that the member.
confidential and proprietary
overview
auto-enrollment
considerations
restrictions
elective enrollment
Auto-enrollment obtains authorization by embedding the permissions in the plan documents
AKA, Reclaim is part of the group health plan.
1.
Plan sponsor modifies their enrollment documents (incl. TOU and Privacy Policy) stating (1) the health information that Reclaim will use and/or disclose to perform its services and (2) Reclaim may contact employees or dependents to deliver services.
1.
At the time of enrollment, employees enroll themselves and dependents in benefits and are informed of the plan's Terms of Use, Privacy Policy, and uses and disclosures of their data. When electing the group health plan, they accept these terms.
2.
When enrolling themselves and their dependents in the group health plan, employees accept the plan's TOU and Privacy Policy, on their and their dependents' behalves, including accepting the terms and data privacy related to Reclaim's services.
2.
Before or during the plan year, employees or dependents may direct the plan to opt them out of receiving Reclaim services, which shall otherwise generally remain in effect for the employee’s period of coverage.
3.
Employees or dependents may direct the plan to opt them out of receiving Reclaim services, which shall otherwise generally remain in effect for the employee’s period of coverage.
3.
Employees are permitted choose and enroll dependents in available benefits. In so doing, so do they have the ability to authorize those dependents' acceptance of the plan's terms and practices.
ELECTIVE enrollment
blended approach
AUTO-ENROLLMENT
overview
restrictions
legal docs
marketing
overview
framework
advantages
considerations
List of legal docs required for auto-enrollment
[PLAN] TERMS OF USE
Privacy. We offer our services to you in accordance with our Privacy Policy, which is hereby incorporated into this Agreement. Each party shall comply with the Privacy Policy, a copy of which is available online here: [Plan’s URL]. By accepting these Terms of Use, you acknowledge that you have read, understood, and had an opportunity to ask us questions regarding the Privacy Policy, which details the ways in which we use your Personal Information that we collect from you and the circumstances in which we may disclose this Personal Information to third-parties. In particular, as a [Member / Beneficiary] of [Plan], you will receive specific benefit services including [requesting re-submission of healthcare claims upon review for accuracy, negotiating billed charges with healthcare providers, filing appeals, filing voluntary benefit reimbursement claims, filing FSA/HRA reimbursement claims] (collectively, “Benefit Services”). The Privacy Policy explains how we will generally disclose your Personal Information to a third-party contractor that we have engaged to manage these Benefit Services in accordance with applicable law. It further explains the right of any such third-party contractor to use and further disclose your Personal Information and contact you in connection with the performance of the Benefit Services; and certain rights that you have in connection with the Benefit Services, such as the right to “opt out” of any disclosure of your Personal Information to the third-party contractor.
Language to add to Plan's TOU
Outlines clause to add in enrollment document's terms of use
Language to add to Plan's PP
Outlines clause to add in enrollment document's privacy policy
Opt-out notice and process
Notice at collection and annual reminders
Page 11
Reclaim Privileged & Confidential
ELECTIVE enrollment
blended approach
AUTO-ENROLLMENT
overview
PRIVACY POLICY
restrictions
legal docs
marketing
overview
framework
advantages
considerations
Use and Disclosure of Personal Information for Certain Benefit Services. We generally will not share or disclose any Personal Information with any third-parties, except in accordance with applicable law. However, as a [Member / Beneficiary] of [Plan], you will receive specific benefit services including [requesting re-submission of healthcare claims upon review for accuracy, negotiating billed charges with healthcare providers, filing appeals, filing voluntary benefit reimbursement claims, filing FSA/HRA reimbursement claims] (collectively, “Benefit Services”). In accordance with applicable law, we may generally disclose your Personal Information to a third-party contractor that we have engaged to manage these Benefit Services (each a “Contractor”) on your behalf. Your receipt of the Benefit Services constitutes your authorization that the Contractor may act on your behalf to effectuate the Benefit Services. In particular, the Contractor may use your Personal Information to communicate with your healthcare providers and review and submit claims for healthcare services that you receive. The Contractor may also further disclose your Personal Information to third-parties including, for example, a voluntary benefit carrier or Flexible Spending Account administrator. In each such instance, the Contractor will only use and further disclose the minimum amount of your Personal Information that the Contractor reasonably requires to perform the Benefit Services; however, Personal Information that the Contractor further discloses to a third-party in connection with the Benefit Services may no longer be protected under any federal or state data privacy law. We will generally enter an agreement with each Contractor limiting their use and further disclosure of your Personal Information to the performance of the Benefit Services; requiring the Contractor to report any suspected or actual breach of security or other incident related to your Personal Information to us; and requiring the Contractor to adhere to the same level of privacy requirements that are required of us under all applicable law. By requesting that we provide you with any Benefit Services, you consent to our sharing your Personal Information with any Contractor and to the Contractor’s use of your Personal Information in accordance with all applicable law and this Policy. You also grant the Contractor permission to contact you as needed in connection with the performance of the Benefit Services, through any contact information that you have provided to us (and which we have disclosed to the Contractor pursuant to this section). Please contact us by telephone at [Plan’s Telephone Number] or email at [Plan’s Email Address] if you have any questions about our disclosure of your Personal Information to a Contractor or the Contractor's subsequent use or further disclosure of your Personal Information for the performance of Benefit Services. You may also contact us in this manner to request that we do not disclose your Personal Information to a Contractor for this purpose, or if you would like us to instruct any Contractor who has previously received your Personal Information to destroy, delete, or return it. We will generally honor all such requests. However, if you opt out of the use and disclosure of your Personal Information in this manner, you may no longer be eligible to receive the Benefit Services to the extent that a Contractor requires your Personal Information to perform them. For the purposes of this section, all references to “you” and “your” shall be considered to apply not only to you, but also to any of your covered dependents who receive the Benefit Services under the policy you hold as a [Member / Beneficiary] of [Plan].
List of legal docs required forauto-enrollment
Language to add to Plan's TOU
Outlines clause to add in enrollment document's terms of use
Language to add to Plan's PP
Outlines clause to add in enrollment document's privacy policy
Opt-out notice and process
Notice at collection and annual reminders
Page 12
Reclaim Privileged & Confidential
restrictions
marketing
Plain language messaging and collateral with opt-out notice
One page explainer
Template HR/consultants may use to enclose in benefits package
Annual reminder communication
Template HR may use to annually remind employees of Reclaim's embedded services and their ability to opt-out, should they choose to
Plain language messaging and collateral with opt-out notice
One page explainer
Template HR/consultants may use to enclose in benefits package
Annual reminder communication
Template HR may use to annually remind employees of Reclaim's embedded services and their ability to opt-out, should they choose to
Trusted by 100+ employers and 1.5M families to control of their healthcare spend.
confidential & proprietary
Rosendin Reclaim Revised Proposal 2/3/26
Reclaim Health
Created on July 31, 2025
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Transcript
“Got my daughter’s bill knocked down from $800 to a $30 co-pay! I love Reclaim! ”
Dena, Reclaim user
Optimizing every dollar spent on healthcare with AI.
https://www.wtwco.com/en-us/insights/2024/11/soaring-healthcare-costs-spark-us-employers-urgent-mission-cut-costs-and-boost-affordability
Despite your best efforts, healthcare remains largely unaffordable.
The unrealized value of your benefits is hindering your healthcare affordability initiatives.
Unexpected.
Received erroneous bills2
45%
74%
forfeited.
Forfeited FSA funds3
47%
of families struggle to afford healthcare1
unrealized.
Missed filing for eligible voluntary benefits4
90%
References: [1] 2024 KFF survey, [2] 2024 The Commonwealth Fund, [3] 2024 EBRI, [4] 2019 SHRM
confidential & proprietary
https://www.voya.com/news/2021/03/voya-financial-introduces-new-claims-model-to-help-american-workers-maximize-their
https://www.voya.com/news/2021/03/voya-financial-introduces-new-claims-model-to-help-american-workers-maximize-their
https://www.ebri.org/content/new-analysis-of-3.2-million-flexible-spending-accounts-finds-average-contributions-increasing-while-half-forfeiting-funds-to-their-employers
Optimizing every dollar spent on healthcare.
confidential & proprietary
Optimizing benefits to healthcare dollars for employers and their employees.
it all starts with detailed claims data
analytics insights and Simulation
AI-POWERED proactive bill savings
personalized benefit optimization
Past and ongoing medical & Rx for covered employees and dependents.
Real-time reporting of overcharges, recovered dollars, and member engagement. Simulate benefit plan changes.
100% claims reviewed for accuracy, with proactive recovery of overcharges, and owed benefits.
Year-round utilization and expense prediction and benefit recommendation in context of bill review.
confidential & proprietary
Powered by claims data & world-class AI.
100
claims reviewed 24/7/365 powered by AI with scalability
"Having actual claims data makes it do its magic! Employees appreciate the valuable insight and guidance it provides."
"Thank you for your thorough review! I had no clue I could get this reimbursed. Very much appreciated!!"
79
Dir. Total Rewards
Sr. Logistics Mngr
Financial Services
Mfg. Company
activations enabling recovery without employee action.
confidential & proprietary
budgeting
Claims
bill savings
Personalized. Powered by claims data.
Comprehensive, line by line medical and Rx claims for all covered lives. Claims access through our existing data use agreements with TPAs nationwide or employer's data warehouse.
confidential & proprietary
budgeting
Claims
bill savings
Proactive claims review and resolution.
Proprietary algorithms highlighting:
confidential & proprietary
budgeting
Claims
bill savings
Proactive claims review and resolution.
Proprietary algorithms highlighting:
"Thank you for your thorough review! I had no idea I could get this corrected. Very much appreciated!!"
Sr. Logistics Manager
Mfg. Company
confidential & proprietary
https://ttlc.intuit.com/community/tax-credits-deductions/discussion/if-i-receive-a-refund-from-a-medical-provider-paid-through-an-hsa-account-is-it-necessary-to-deposit/00/46839
https://www.reddit.com/r/personalfinance/comments/1hppdnh/refund_to_fsa_card_not_hitting_until_2025_what/
"Thank you for ensuring I was not double billed!"
background
An employee had a diagnostic colonoscopy that turned into a treatment colonoscopy with polyp removal. The employee (and employer) were billed for both services, when the treatment colonoscopy should have only been billed.
employeE saved
AI detects coding Error
reclaim requests bill review
provider re- submits claim
TPA processes employer credit
WE reconcile patient credit
$1K
AI alerts Reclaim advocates of bill error & detailed course of action. Opportunity shared with employer & employee.
We contact provider requesting bill review & ensuring bill collection is paused. Status shared with employer & employee.
Formal claim re-submission allows noting credits for both employer & employee. Status shared with employer & employee.
TPA adjusts claim(s) & issues employer credits. Reclaim monitors claim adjustment and credits in next claims feed.
We request provider reimburse patient. When applicable, we coordinate with member to process HSA mistaken distribution.
employeR saved
$4K
confidential & proprietary
Reversed patient overpayments
Correcting miscoding, duplicate claims, etc.
FSA, voluntary reimbursements
Employee spotlight
Employee spotlight
"Thank you for reviewing my current medical plan spending and recommending I change plans because I am overpaying! Very helpful!"
First name
Role and perhaps context as to how much she got in payouts.
"I had no clue I am owed money. Thank you very much for helping me get reimbursed! Very much appreciated!"
"I had no clue I am owed money. Thank you very much for helping me get reimbursed! Very much appreciated!"
First name
First name
First name
Role and perhaps context as to how much she got in payouts.
Role and perhaps context as to how much she got in payouts.
Role and perhaps context as to how much she got in payouts.
"I had no clue I could get this reimbursed!"
background
Matt had a sports injury that left him with several fractured bones that had him skip weeks from work. Matt forgot he had enrolled in an accident plan and had been auto-renewing it. Reclaim detected he is eligible for a voluntary benefit (VB) payout and proactively filed and secured the payment on his behalf.
VB issues reimbursement
employee saved
reclaim monitors status
reclaim detects VB opportunity
reclaim initiates Filing
Check mailed to employee with final payout confirmed.
Status updates, incl. follow up on addt'l documentation.
Upon claims data receipt, AI triggers accident payout.
Automated filing for preferred voluntary benefit partners.
$18K
confidential & proprietary
Reversed patient overpayments
Correcting miscoding, duplicate claims, etc.
FSA, voluntary reimbursements
Employee spotlight
Employee spotlight
"Thank you for reviewing my current medical plan spending and recommending I change plans because I am overpaying! Very helpful!"
First name
Role and perhaps context as to how much she got in payouts.
"I had no clue I am owed money. Thank you very much for helping me get reimbursed! Very much appreciated!"
"I had no clue I am owed money. Thank you very much for helping me get reimbursed! Very much appreciated!"
First name
First name
First name
Role and perhaps context as to how much she got in payouts.
Role and perhaps context as to how much she got in payouts.
Role and perhaps context as to how much she got in payouts.
budgeting
Claims
bill savings
Optimized benefits and budgeting.
Collaborative filtering yielding time-based utilization predictions. Out of pocket prediction & pre-tax contribution optimization.
"Having actual claims data makes it do its magic! Employees appreciate the valuable insight and guidance it provides."
Director, Total Rewards
Financial Services Company
confidential & proprietary
Reclaiming healthcare dollars.
Employer & employees
Employees
Billing corrections
Reimbursed benefits
Per 10K covered families
$6.3M
~ 3.5% of total medical spend across our BoB
Employer & employees
Employer
HSA/FSA tax benefits
Medicare transitions
real dollars back in employer's budget and their employees' pockets
confidential & proprietary
CONFIDENTIAL AND PROPRIETARY
Annual Potential Financial Opportunity
Overbilling correction
Return distribution
$99K
VB Payout*
Potential return
Employer
$150K
$300K/Year
~40%
HSA/FSA Contribution
$51K
Tax savings
Employee
Medicare Transitions
~60%
$0
Page 9
Traditional PEPM Pricing Proposal
Proposed pricing based on a 3-year agreement.
confidential & proprietary
Potential return on investment.
*Based on population based assumptions and optimal deployment.
confidential & proprietary
Optimizing every dollar your healthcare benefits have to offer.
Optimized benefits
Payment advocacy
Analytics & reporting
confidential & proprietary
Integrated with your ecosystem and optimized rollout to maximize savings.
03
02
04
01
Rollout
Benefits
Delivery
Claims
Opt in model by partnering with benefit admin to collect consents at enrollment. When presented at the time of benefits selection, an average of 79% activate in year 1.
Benefit design details captured in partnership with employer and their consultant(s). Enrollment & eligibility captured via backend integrations with employer's benefit admin.
Member-facing app (web and mobile), standalone or embedded in employer's benefit app. Analytics dashboard with real-time access to insights, savings reports, with role-based access,
Established data use agreements with national carriers & a growing number of regional TPAs.
confidential & proprietary
Employee spotlight
Employee spotlight
"Thank you for reviewing my current medical plan spending and recommending I change plans because I am overpaying! Very helpful!"
First name
Role and perhaps context as to how much she got in payouts.
"I had no clue I am owed money. Thank you very much for helping me get reimbursed! Very much appreciated!"
"I had no clue I am owed money. Thank you very much for helping me get reimbursed! Very much appreciated!"
First name
First name
First name
Role and perhaps context as to how much she got in payouts.
Role and perhaps context as to how much she got in payouts.
Role and perhaps context as to how much she got in payouts.
power giving to us by the employer group plan. Bounded by TPO - HIPAA permits it in that regard. implicit that member is on notice that the member.
confidential and proprietary
overview
auto-enrollment
considerations
restrictions
elective enrollment
Auto-enrollment obtains authorization by embedding the permissions in the plan documents
AKA, Reclaim is part of the group health plan.
1.
Plan sponsor modifies their enrollment documents (incl. TOU and Privacy Policy) stating (1) the health information that Reclaim will use and/or disclose to perform its services and (2) Reclaim may contact employees or dependents to deliver services.
1.
At the time of enrollment, employees enroll themselves and dependents in benefits and are informed of the plan's Terms of Use, Privacy Policy, and uses and disclosures of their data. When electing the group health plan, they accept these terms.
2.
When enrolling themselves and their dependents in the group health plan, employees accept the plan's TOU and Privacy Policy, on their and their dependents' behalves, including accepting the terms and data privacy related to Reclaim's services.
2.
Before or during the plan year, employees or dependents may direct the plan to opt them out of receiving Reclaim services, which shall otherwise generally remain in effect for the employee’s period of coverage.
3.
Employees or dependents may direct the plan to opt them out of receiving Reclaim services, which shall otherwise generally remain in effect for the employee’s period of coverage.
3.
Employees are permitted choose and enroll dependents in available benefits. In so doing, so do they have the ability to authorize those dependents' acceptance of the plan's terms and practices.
ELECTIVE enrollment
blended approach
AUTO-ENROLLMENT
overview
restrictions
legal docs
marketing
overview
framework
advantages
considerations
List of legal docs required for auto-enrollment
[PLAN] TERMS OF USE
Privacy. We offer our services to you in accordance with our Privacy Policy, which is hereby incorporated into this Agreement. Each party shall comply with the Privacy Policy, a copy of which is available online here: [Plan’s URL]. By accepting these Terms of Use, you acknowledge that you have read, understood, and had an opportunity to ask us questions regarding the Privacy Policy, which details the ways in which we use your Personal Information that we collect from you and the circumstances in which we may disclose this Personal Information to third-parties. In particular, as a [Member / Beneficiary] of [Plan], you will receive specific benefit services including [requesting re-submission of healthcare claims upon review for accuracy, negotiating billed charges with healthcare providers, filing appeals, filing voluntary benefit reimbursement claims, filing FSA/HRA reimbursement claims] (collectively, “Benefit Services”). The Privacy Policy explains how we will generally disclose your Personal Information to a third-party contractor that we have engaged to manage these Benefit Services in accordance with applicable law. It further explains the right of any such third-party contractor to use and further disclose your Personal Information and contact you in connection with the performance of the Benefit Services; and certain rights that you have in connection with the Benefit Services, such as the right to “opt out” of any disclosure of your Personal Information to the third-party contractor.
Language to add to Plan's TOU
Outlines clause to add in enrollment document's terms of use
Language to add to Plan's PP
Outlines clause to add in enrollment document's privacy policy
Opt-out notice and process
Notice at collection and annual reminders
Page 11
Reclaim Privileged & Confidential
ELECTIVE enrollment
blended approach
AUTO-ENROLLMENT
overview
PRIVACY POLICY
restrictions
legal docs
marketing
overview
framework
advantages
considerations
Use and Disclosure of Personal Information for Certain Benefit Services. We generally will not share or disclose any Personal Information with any third-parties, except in accordance with applicable law. However, as a [Member / Beneficiary] of [Plan], you will receive specific benefit services including [requesting re-submission of healthcare claims upon review for accuracy, negotiating billed charges with healthcare providers, filing appeals, filing voluntary benefit reimbursement claims, filing FSA/HRA reimbursement claims] (collectively, “Benefit Services”). In accordance with applicable law, we may generally disclose your Personal Information to a third-party contractor that we have engaged to manage these Benefit Services (each a “Contractor”) on your behalf. Your receipt of the Benefit Services constitutes your authorization that the Contractor may act on your behalf to effectuate the Benefit Services. In particular, the Contractor may use your Personal Information to communicate with your healthcare providers and review and submit claims for healthcare services that you receive. The Contractor may also further disclose your Personal Information to third-parties including, for example, a voluntary benefit carrier or Flexible Spending Account administrator. In each such instance, the Contractor will only use and further disclose the minimum amount of your Personal Information that the Contractor reasonably requires to perform the Benefit Services; however, Personal Information that the Contractor further discloses to a third-party in connection with the Benefit Services may no longer be protected under any federal or state data privacy law. We will generally enter an agreement with each Contractor limiting their use and further disclosure of your Personal Information to the performance of the Benefit Services; requiring the Contractor to report any suspected or actual breach of security or other incident related to your Personal Information to us; and requiring the Contractor to adhere to the same level of privacy requirements that are required of us under all applicable law. By requesting that we provide you with any Benefit Services, you consent to our sharing your Personal Information with any Contractor and to the Contractor’s use of your Personal Information in accordance with all applicable law and this Policy. You also grant the Contractor permission to contact you as needed in connection with the performance of the Benefit Services, through any contact information that you have provided to us (and which we have disclosed to the Contractor pursuant to this section). Please contact us by telephone at [Plan’s Telephone Number] or email at [Plan’s Email Address] if you have any questions about our disclosure of your Personal Information to a Contractor or the Contractor's subsequent use or further disclosure of your Personal Information for the performance of Benefit Services. You may also contact us in this manner to request that we do not disclose your Personal Information to a Contractor for this purpose, or if you would like us to instruct any Contractor who has previously received your Personal Information to destroy, delete, or return it. We will generally honor all such requests. However, if you opt out of the use and disclosure of your Personal Information in this manner, you may no longer be eligible to receive the Benefit Services to the extent that a Contractor requires your Personal Information to perform them. For the purposes of this section, all references to “you” and “your” shall be considered to apply not only to you, but also to any of your covered dependents who receive the Benefit Services under the policy you hold as a [Member / Beneficiary] of [Plan].
List of legal docs required forauto-enrollment
Language to add to Plan's TOU
Outlines clause to add in enrollment document's terms of use
Language to add to Plan's PP
Outlines clause to add in enrollment document's privacy policy
Opt-out notice and process
Notice at collection and annual reminders
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Reclaim Privileged & Confidential
restrictions
marketing
Plain language messaging and collateral with opt-out notice
One page explainer
Template HR/consultants may use to enclose in benefits package
Annual reminder communication
Template HR may use to annually remind employees of Reclaim's embedded services and their ability to opt-out, should they choose to
Plain language messaging and collateral with opt-out notice
One page explainer
Template HR/consultants may use to enclose in benefits package
Annual reminder communication
Template HR may use to annually remind employees of Reclaim's embedded services and their ability to opt-out, should they choose to
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