Terms of Employee Enrollment
V1.2 | As of November 24, 2025
A. Responsibility to Report Status Changes Promptly
I agree to notify Human Resources at my employer within 30 days if I or any of my eligible dependents experience a qualified family status change such as marriage, divorce, birth, or loss of coverage.
B. Understanding of Coverage and Plan Rules (For Group Sponsored Plan)
I acknowledge that my benefit elections are subject to plan rules, insurance carrier requirements, marketplace processing timelines and requirements, and applicable laws. I understand certain benefits may require evidence of insurability or approval.
I understand and acknowledge that by completing the checkout process on the CVRD platform, I am accepting my employer-sponsored ICHRA plan and agreeing to comply with all associated plan rules, requirements, and terms of participation.
Coordination of Benefits
I understand that if I or my dependents are covered under another health plan, benefits may be coordinated according to plan rules. I understand that CVRD Health Solutions LLC and/or related partners and affiliates will be coordinating enrollment on my behalf and may assume Agent of Record for my enrollments. I agree and consent to this AOR designation through my employer enrollment process.
C. ACA Declination of Minimum Essential Coverage (MEC) Acknowledgement
By declining the health coverage offered by my employer, I acknowledge and understand the following:
- My employer has offered me health coverage that qualifies as Minimum Essential Coverage (MEC) under the Affordable Care Act (ACA).
- I am voluntarily declining this coverage.
- I understand that by declining this coverage, I will not be able to enroll in the employer-sponsored health plan until the next open enrollment period, unless I experience a qualifying life event that allows for a special enrollment period.
- I acknowledge that declining MEC may affect my eligibility for premium tax credits or subsidies if I seek coverage through the Health Insurance Marketplace.
Required Agent of Record for Participation
I understand and acknowledge that appointing CVRD Health Solutions LLC as my Agent of Record is mandatory for receiving enrollment support and participating in my employer's benefits program. Without this AOR designation, CVRD Health Solutions LLC cannot provide enrollment assistance or ongoing support services.
D. Employer’s Right to Modify or Terminate Plans
I understand my employer reserves the right to amend or terminate benefit plans at any time, subject to applicable laws.
E. ICHRA Plan Acknowledgement
If offered an ICHRA plan:
- The ICHRA is a group health plan for eligible individual health insurance premiums only. This ICHRA does not reimburse other out-of-pocket medical expenses.
- To participate, I must be enrolled in individual health insurance coverage that qualifies as individual health insurance under the rules set forth by the Affordable Care Act. This includes coverage purchased through a public Exchange/Marketplace or directly from an insurance carrier (off-Exchange), but does not include short-term limited duration plans, healthcare sharing ministries, or other non-qualifying coverage.
- I understand that the ICHRA qualifies as an employer-sponsored group health plan for purposes of the Affordable Care Act (ACA). If the ICHRA offer meets ACA affordability standards, I will not be eligible for premium tax credits or subsidies through the Health Insurance Marketplace for the months that I am eligible for the ICHRA.
- I understand that participation in the ICHRA does not make my employer the policyholder or responsible for my individual policy. The policy is owned by me and coverage terms are governed by the insurer issuing my individual plan.
Required Agent of Record (AOR) Designation
I understand and acknowledge that appointing CVRD Health Solutions LLC as my Agent of Record is a mandatory requirement for participation in the ICHRA plan and enrollment administration process. Without this AOR designation, CVRD Health Solutions LLC cannot and will not assume responsibility for my health plan enrollment or ongoing administration. I agree that this AOR designation is an essential component of my ICHRA participation and employer-sponsored benefits administration.
F. Market Changes and Plan Availability
I understand and acknowledge that health insurance rates, premiums, plan designs, and carrier availability in the individual health insurance market are subject to change and are beyond the control of CVRD Health Solutions LLC, my employer, and any affiliated partners. While CVRD Health Solutions LLC will make reasonable efforts to enroll me in my elected health plans, I understand that:
- Market conditions, including premium rates and plan availability, may change during or after the enrollment process.
- Insurance carriers may modify, discontinue, or limit availability of plans at any time. Plan features, networks, and benefits may be updated by carriers in accordance with applicable laws and regulations.
- CVRD Health Solutions LLC will notify me promptly of any material changes that affect my coverage options or elected plans, but cannot be held responsible or liable for changes in the marketplace, carrier decisions, or plan modifications that are beyond its control.
G. Hold Harmless and Administrative Services Acknowledgement
I understand and acknowledge that CVRD Health Solutions LLC will act as my administrator for purposes of health insurance enrollment and ongoing benefits administration. In this capacity, CVRD Health Solutions LLC will:
- Access, review, and use my personal and health information as necessary to fulfill administrative duties.
- Complete enrollment applications and related documentation on my behalf. Communicate with insurance carriers, exchanges, and other third parties as my designated representative.
- Provide ongoing account maintenance and customer service related to my health insurance coverage.
I acknowledge and agree that:
Any and all information related to my health insurance enrollment and administration may be shared with me upon request, but I understand that CVRD Health Solutions LLC must maintain this information to properly administer my benefits. All actions taken by CVRD Health Solutions LLC on my behalf are performed in good faith as my authorized administrator to facilitate my health insurance coverage. I agree to hold CVRD Health Solutions LLC, its officers, employees, agents, and affiliated partners harmless from any and all claims, liabilities, damages, or expenses arising from the enrollment and administrative services provided on my behalf, except in cases of gross negligence or willful misconduct. I understand that CVRD Health Solutions LLC is acting as an administrator and intermediary between myself, my employer, and insurance carriers, and that the ultimate coverage terms and conditions are determined by the insurance carrier and applicable laws.
H. Standard Fraud Warning/Enrollment Attestation
Any person who knowingly and with intent to defraud injure or deceive an insurer or other person submits an enrollment for insurance or files a claim containing false, incomplete, or misleading information may be guilty of insurance fraud. Penalties may include fines, restitution, denial of insurance benefits, civil damages, and/or imprisonment depending on state law.
I. SBM and EDE Enrollment Consent
I give my permission to CVRD Health Solutions LLC ("Agent") to serve as the health insurance Agent or broker for myself and my entire household if applicable, for purposes of enrollment in a Qualified Health Plan offered on the Federally-Facilitated Marketplace or State Based Marketplace. By consenting to this agreement, I authorize the above-mentioned Agent to view and use the confidential information provided by me in writing, electronically, or by phone only for one or more of the following:
- Searching for an existing Marketplace application
- Completing an application for eligibility and enrollment in a Marketplace Qualified Health Plan or an application for government insurance affordability programs, such as Medicaid and CHIP or advance payments of the premium tax credit to help pay for Marketplace premiums
- Providing ongoing account maintenance and enrollment assistance, as necessary
- Responding to inquiries from the Marketplace regarding my application
I understand that the Agent will not use or share my personally identifiable information (PII) for any purposes other than those listed above. The Agent will ensure that my PII and PHI is protected when creating, collecting, disclosing, accessing, maintaining, storing, and using my PII for the stated purposes above.
I understand that I do not have to share additional PII or PHI with my Agent beyond what is required on the application for eligibility and enrollment purposes (and requirements may vary by state). I understand that my consent remains in effect until I revoke it, and I may revoke or modify my consent at any time by contacting my Agent.
I confirm that the information I provide to my employer or the Agent for entry on my Marketplace eligibility and enrollment application will be true to the best of my knowledge.
Final Attestation
By completing this enrollment, I affirm that all information I have provided is true, complete, and accurate to the best of my knowledge. I understand that providing false, incomplete, or misleading information may result in denial of benefits, termination of coverage, or other consequences as permitted by law. I acknowledge that I have read, understood, and agree to all terms and conditions set forth in this document.
CVRD Health, Inc. Terms of Employee Enrollment Version 1.2 Last revised: November 24, 2025