Welcome to Thatch! This Member Agreement ("Member Agreement") is an agreement between Thatch Health, Inc. ("Thatch" or "we") and the person registering to use the services provided by Thatch ("Member" or "you"). This Member Agreement applies to your access and use of the products or services provided by Thatch or its partners.
This Member Agreement is effective when you first access your account with Thatch ("Effective Date") and remains in effect for the term provided below.
This Member Agreement incorporates additional agreements, terms, and policies (collectively, "Incorporated Terms") including Thatch Platform Terms ("Platform Terms"), the Privacy Policy ("Privacy Policy"), the Consumer Deposit Account Agreement and Debit Cardholder Agreement and any other agreements between you and financial partners (collectively, the "Financial Partner Agreements"), and the Acceptable Use Policy ("Acceptable Use Policy"). The Member Agreement and Incorporated Terms form the entirety of the agreement governing your use of Member Accounts. Any capitalized terms used but not defined in this Member Agreement will have the definitions provided in the Platform Terms.
We aim to make this Member Agreement easy to understand but please contact us if you have any questions. There are a few important items for you to note about your use of our services:
Acceptance of Terms. Your use of our services is subject to your acceptance of all the terms and conditions of this Member Agreement including the Incorporated Terms. This Member Agreement is a User Agreement as defined in the Platform Terms. If you do not agree to all the terms and conditions of this Member Agreement, you may not access or use any products, services, or applications provided by Thatch.
This Member Agreement includes terms that impact your access to services, limit our liability, waive class actions, and require you to settle disputes through arbitration. Disputes between you and Thatch will be resolved by binding, individual arbitration as described in the Platform Terms that includes a waiver of your right to participate in a class action lawsuit or class-wide arbitration.
Thatch is not a custodian, trustee, or fiduciary for your Healthcare Payments Accounts; and Thatch is not an insurer or Carrier. Other parties, including partner banks, provide these services that you can access through your Thatch dashboard. Thatch does not underwrite or issue any insurance policies but works with Carriers to provide access to you.
Thatch does not offer medical advice or treatment. Only medical professionals can advise and determine the right courses of treatment and provide safe, appropriate, and effective treatments. IN THE CASE OF A MEDICAL EMERGENCY, IMMEDIATELY SEEK TREATMENT AT YOUR NEAREST EMERGENCY ROOM OR CALL 911.
1. Using Your Member Account
A. About Your Member Account
A Member Account can be used for viewing and evaluating Healthcare Notices, using Healthcare Payments Accounts, managing personal and contact information, and modifying payment sources including your Financial Account. Depending on the type of Healthcare Payments Account offered by your Employer, you may be able to use your Member Account to shop for Individual Plans.
B. Opening Your Member Account
Once your Employer signs up for Thatch, you will receive an invitation to use Healthcare Payments Accounts provided as part of your Member Account. Your invitation will include your Healthcare Notices, information about your benefits including eligibility and Healthcare Contribution Amounts, any applicable deadlines, and instructions for accepting or declining the benefits offer. Your invitation will also include a link to the Thatch website where you can create a Member Account. Please read your Healthcare Notices carefully because they include important information about your Healthcare Payments Accounts.
You need to create a Member Account before accessing Services, dashboards, and Healthcare Payments Accounts. Your Member Account dashboard will allow you to input and manage personal information, connect a Financial Account, enroll in healthcare or modify your healthcare elections, and pay for healthcare.
C. Enrolling in an Individual Plan
To participate in an ICHRA you must be enrolled in Individual Plans at all times. You can purchase Individual Plans through Thatch, Exchanges, or directly from Carriers. While we make certain Insurance Plans available for purchase through Thatch, they are not exhaustive and you may find other Insurance Plans that are more appropriate for your needs sold directly from Carriers or Exchanges.
D. Keeping Your Member Account Current
You are responsible for keeping information in your Member Account current at all times, including your home address, Dependents, and your employment status.
You are responsible for any consequences of untimely updates to your Member Account, including lack of healthcare coverage for you or a Dependent or additional amounts owed to Carriers.
Where Carriers require additional documentation, including evidence that you experienced a Qualifying Life Event, you are responsible for providing this information to them.
E. Appointing a Broker
When you enroll in an Individual Plan, you have the option to designate a Broker in connection with your enrollment. Members are not required to designate a Broker. Brokers may receive Commissions for placement of Insurance Plans.
Default Broker Designation. When you enroll in an Individual Plan through Thatch’s website, Thatch Health Insurance Services LLC will be your Broker unless you designate otherwise.
Broker Authorization. You authorize the Broker to access information and facilitate transactions on behalf of you or your Dependents, which include but are not limited to (a) helping the Member or their Dependents evaluate a healthcare benefits offer on Thatch, (b) helping the Member or their Dependents enroll in and pay for Individual Plans, (c) helping the Member or their Dependents make changes related to or terminate their Individual Plans, (d) helping the Member or their Dependents manage claims issues with Carriers, and (e) helping the Member or their Dependents research provider networks.
F. Paying for Healthcare and Medical Expenses
There are several ways to pay for healthcare and Qualified Medical Expenses using your Healthcare Payments Accounts.
On-Thatch Purchases. Members can use Healthcare Payments Accounts to purchase healthcare or Qualified Medical Expenses on Thatch’s website. Where possible, Thatch will fund the transaction using Healthcare Contribution Amounts.
Thatch Card. Depending on your Healthcare Payments Account, you may be able to request virtual or physical Thatch Cards to pay for healthcare or Qualified Medical Expenses outside of Thatch’s website. Thatch Cards are available to Members participating in Healthcare Payments Accounts that reimburse both healthcare and Qualified Medical Expenses and to Members with legacy HSAs. Purchases using your Thatch Card that exceed your Healthcare Contribution Amounts may be declined. Thatch reserves the right in its sole discretion to suspend or terminate Members’ Thatch Card access for noncompliance with the Member Agreement or Acceptable Use Policy.
Reimbursements. If you incur expenses using a payment instrument other than a Thatch Card, you can submit a reimbursement request to Thatch. Depending on your Healthcare Payments Accounts, you may be reimbursed directly to your Financial Account.
Premium Advances. Carriers sometimes bill Individual Plan premiums before the applicable coverage period. When they do so, Thatch may make the payment to the Carrier and create an Advance on your behalf.
Physical Mail. When Thatch enrolls you in coverage, we may provide a Thatch-controlled mailing address to the Carrier or another third party assisting with your enrollment or premium payments. You authorize Thatch or its vendors to receive, open, process, and respond to messages addressed to you from Carriers concerning your enrollment or premium payments.
G. Continuation of Coverage
When your employment terminates, you may have limited access to unused Healthcare Contribution Amounts depending on the terms of your Healthcare Payments Accounts specified in your Healthcare Notices. For example, if you had an ICHRA, you will assume responsibility to pay for your Insurance Coverage at your own expense.
Certain Employers and Healthcare Payments Accounts may be subject to COBRA. If so, your Employer may elect to administer COBRA in connection with your Healthcare Payments Accounts and you may retain access to their Healthcare Payments Accounts by paying a monthly fee ("COBRA Premium"). Your COBRA terms may be provided for in additional Healthcare Notices at the time of your termination.
2. Member Payments and Fees
A. Payments from Healthcare Payments Accounts
You can use your Healthcare Payments Accounts to pay for healthcare and Qualified Medical Expenses up to your Healthcare Contribution Amounts, subject to the terms of your Healthcare Notices. Expenses paid for using your Healthcare Payments Accounts are tax-free to the extent permitted by Applicable Rules. You are responsible for any spending that you incur above your Healthcare Contribution Amounts.
B. Unqualified Amounts
Healthcare Payments Accounts cannot be used to pay for expenses that are not for Individual Plans or Qualified Medical Expense ("Unqualified Amounts"). Thatch may recoup Unqualified Amounts from payroll, a Financial Account, or your Employer.
C. Termination of Healthcare Payments Accounts
If you close your Member Account, you will lose access to your Thatch Card and Thatch will no longer provide payment services for your Insurance Plan. You will be responsible for paying for your healthcare and any other Qualified Medical Expenses until the end of your Healthcare Payments Account’s plan year. If you wish to keep your Insurance Plan after closing your Member Account, you may need to contact your Carrier directly to provide a personal payment method.
3. Closing a Member Account
A. How to Close Your Member Account
You may close your Member Account upon 30 days' notice by contacting support@thatch.ai.
B. Impact on Amounts Owed
After terminating your account, you will be responsible for all charges related to your Insurance Plan or Qualified Medical Expenses including COBRA Premiums, which will be debited from your Financial Account or your payroll, or collected from your Employer. You are responsible for any charges made or expenses we incur on your behalf, including collecting amounts owed.
When you close your Member Account, you will be solely responsible for enrolling in and paying for your own health insurance. You must settle all Advances prior to closing your Member Account. At our election, we may settle from either Financial Accounts or Reserves. All amounts owed are immediately due and payable. After settlement of outstanding obligations, remaining amounts in Reserves will be returned to Financial Accounts you designate.
4. Compliance with Applicable Rules
A. Participation Eligibility
If required by your Healthcare Notices, you must be enrolled in an Individual Plan to use Healthcare Payments Accounts. Your Healthcare Payments Accounts will only reimburse you for eligible expenses for services provided during your Healthcare Payments Account’s plan year while you are enrolled in an Individual Plan.
B. Substantiation
You may be required to substantiate that your expenses are eligible for tax-free treatment. Thatch may be able to automatically substantiate your purchases at the time of your payment. Otherwise, Thatch may require additional documentation to substantiate the transaction. The process for substantiating your payments is specified in your Healthcare Notices.
5. Indemnity
In addition to your indemnification obligations in the Platform Terms, you also agree to indemnify and hold Thatch harmless from and against all Claims brought against Thatch, and any liabilities, damages, losses and expenses (including attorneys' fees), that arise from or relate to your (a) non-compliance with Applicable Rules, (b) failure to keep the Thatch Account account or current, and (c) any other violation of this Member Agreement.
6. Integration
This Member Agreement, including the Incorporated Terms, constitutes the entire understanding of the Parties with respect to subject matter described herein. It supersedes all prior and contemporaneous understandings and agreements between you and us regarding the Services
