Terms and ConditionsEffective Date: October 1, 2013
The following are the terms and conditions (“Terms and Conditions”) of a legal agreement (“Agreement”) between you and San Francisco Health Plan (“SFHP”), the administrator of the San Francisco City Option Program, relating to the use of the San Francisco City Option Employer Portal website (“Employer Portal”) and services of the San Francisco City Option Program. For purposes of the Terms and Conditions, the terms “we,” “us,” and “our” refer to San Francisco Health Plan and its affiliates.
BY USING THE EMPLOYER PORTAL AND/OR SERVICES OF THE SAN FRANCISCO CITY OPTION PROGRAM, YOU ARE INDICATING THAT YOU HAVE READ, UNDERSTAND, AND AGREE TO BE BOUND BY THE TERMS AND CONDITIONS.
If you are entering into this Agreement on behalf of an employer or other legal entity, you represent and warrant that you have the authority to bind such entity and its affiliates to the Terms and Conditions, in which case the terms “you” or “your” shall refer to such entity and its affiliates. If you do not have such authority, or if you do not agree with the Terms and Conditions, you must not accept this Agreement and may not use the Employer Portal or our services.
2. Employer Portal AccountsEmployer Accounts.
In order to use the Employer Portal, you must have an account in the Employer Portal for the employer (“Employer Account”). Information we require about the employer includes, but is not limited to, employer legal name, fictitious business name (if any), Tax ID Number (“TIN”), address, phone number, industry classification, company size, and tax status.
Tax ID Number Changes.
Each Employer Account will be associated with the TIN under which the Employer Account was registered. If you have an existing Employer Account and need to change the TIN, you must create a new Employer Account with the new TIN (“New Employer Account”).
Medical Reimbursement Accounts (“MRAs”) funded by health care contributions through your New Employer Account (“New MRAs”) are separate from MRAs funded by health care contributions through your former Employer Account (“Earlier MRAs”). New MRAs incur separate administrative fees and have effective dates based on the first payment clearance date on behalf of the employee under the New Employer Account.
Upon your request, we will allow a one-time, temporary effective date change for New MRAs that belong to employees with both New MRAs and Earlier MRAs. The effective date will be temporarily changed to one (1) calendar year before the new effective date. Employees will have thirty (30) calendar days from the date of implementation of the temporary effective date to submit claims for reimbursement from the New MRAs. Employees may be reimbursed for eligible health care expenses incurred on or after the temporary effective date. The effective date of the New MRAs will revert back to the actual effective date after thirty (30) calendar days, after which employees may only be reimbursed for eligible health care expenses incurred on or after the actual effective date. Under no other circumstances will we allow effective date changes for MRAs.
An Employer Account may have more than one user profile, each with its own login username and password (“User Account”). Information we require for your User Account includes, but is not limited to, your name, phone number, and email address. You are responsible for maintaining the confidentiality of your User Account login information and for authorizing, monitoring and controlling access to your User Account. You agree to notify us of any unauthorized use or suspected unauthorized use of your User Account or of any other breach of security that you become aware of involving or relating to the Employer Portal.
You represent and warrant that all Employer Account and User Account information you provide to us is truthful and accurate, and you will maintain the accuracy of such information. We reserve the right, in our sole discretion, to suspend or terminate your Employer Account or User Account if any information provided during the registration process or thereafter proves to be inaccurate, not current, or incomplete, or if you engage in an act that would constitute a violation of the Terms and Conditions.
3. Electronic Communications
You agree to provide us with your email address, to promptly provide us with any changes to your email address, and to accept emails or other electronic communications from us at the email address you specify. You agree that we may provide agreements, notices, disclosures, statements, and other communications to you through email. You agree that all communications that we provide to you electronically satisfy any legal requirement that such communications be in writing. You further agree that any communications provided by us electronically are deemed to be given and received on the date we transmit any such electronic communication.
4. Health Care Security Ordinance
Your health care contributions to the San Francisco City Option Program made on behalf of employees are voluntary. You may choose other options for meeting the Employer Spending Requirement of the San Francisco Health Care Security Ordinance (“HCSO”). By accepting your health care contributions, we are not rendering any representation, warranty, or opinion on your compliance with the HCSO or your classification of workers covered under the HCSO.
5. Employee Roster Submissions
The Employer Portal requires you to submit a list that identifies the employees for whom you are making health care contributions (“Employee Roster”). You must provide us with personal information of your employees including, but not limited to, employee name, social security number (“SSN”), date of birth, personal address, personal phone number, and health insurance status in order for us to provide health care services to your employees. Disclosure of employee SSNs is requested from you in order to apply your health care contributions to your employees’ Healthy San Francisco
Accuracy of Employee Information.
You agree, represent, and warrant that the personal employee information you submit in each Employee Roster is: (a) truthful, accurate, and not misleading; and (b) offered in good faith. We rely on the personal employee information you provide to us to contact your employees about accessing the health care benefits under our program. Your failure to provide accurate personal employee information to us may result in our inability to apply your health care contributions on behalf of your employees or delays in applying your health care contributions on behalf of your employees. You agree to promptly address, investigate, and correct issues with personal employee information when we inform you about or you discover problems and discrepancies in personal employee information you submit to us. You may contact us at the email address listed in Section Twenty (20) of the Terms and Conditions for assistance in correcting issues with person employee information.
6. Healthy San Francisco
You understand that submitting an Employee Roster to us does not guarantee that your employees with health care contributions assigned to Healthy San Francisco
are eligible for Healthy San Francisco
. You also understand that submitting an Employee Roster to us does not automatically enroll your employees in Healthy San Francisco
. Your employees will receive information by mail and by phone from us with instructions on how to enroll in Healthy San Francisco
. A representative of Healthy San Francisco
will make the final determination of an employee’s eligibility for Healthy San Francisco
at the employee’s enrollment meeting. Your health care contributions may provide a discount on the quarterly participant fee for your employees who are eligible for Healthy San Francisco
. Employees must apply for enrollment in Healthy San Francisco
prior to the expiration date of their employer participation fee discount to avail themselves to the benefits of your health care contributions on their behalf. If an employee is found ineligible for Healthy San Francisco
, your health care contribution for the employee will be transferred to an MRA if the employee makes a valid request for a transfer of the funds. No refund of health care contributions assigned to Healthy San Francisco
will be provided to you if your employee does not enroll in Healthy San Francisco
7. Medical Reimbursement Accounts
You understand that submitting the Employee Roster to us does not automatically establish MRAs for employees with heath care contributions assigned to MRAs. It may take 4-6 weeks from the payment clearance date of the first health care contribution on behalf of the employee for the employee to receive information in the mail about how to access and use the MRA. The effective date of an MRA is the payment clearance date of the first health care contribution on behalf of the employee. Employees may submit claims for reimbursement for eligible health care expenses incurred on or after the effective date. Unless otherwise specified in the Terms and Conditions, we will not allow effective date changes for MRAs. No refund of health care contributions assigned to MRAs will be provided to you if your employee does not use the MRA.
8. Disclosure of Employee Information
We may disclose personal employee information received through the Employer Portal to third-party service providers for operational and administrative purposes necessary to provide our services. We will never sell personal employee information to a third party.
The payment amount you submit to us must match the amount of the health care contribution specified in the corresponding Employee Roster. Your payment must be received by us within thirty (30) calendar days of the date that the corresponding Employee Roster was submitted in the Employer Portal. Completion of a payment is contingent upon both the authorization of the payment by your financial institution and our acceptance of your payment. Your receipt of an electronic form or other form of confirmation of payment does not signify our receipt of acceptance of your payment. Your payment is deemed to constitute an offer to pay which will be accepted by us only upon valid submission of payment under the Terms and Conditions.
It is your responsibility to provide us with accurate and legitimate financial information to process your payment. We are not responsible for any failure or error in your payment, including without limitation, any interruption, omission, mistake, malfunction or delay related thereto. If your payment is not received within thirty (30) calendar days from the date that the Employee Roster was submitted, your Employee Roster will be un-submitted from the Employer Portal and any payment received after thirty (30) calendar days will be returned to you. If your Employer Roster is not submitted within thirty (30) calendar days of the date that your payment is received by us, your payment will be returned to you.
You are responsible for maintaining the confidentiality of your banking information. We are not responsible for any loss you may incur as a result of unauthorized payments. You are responsible to ensure that there are sufficient funds in your banking account to enable the payment. You are solely responsible for paying any fee and/or interest charged by us or your financial institution due to insufficient funds in your banking account.
Electronic Funds Transfer Payment.
If you choose to send payment to us by electronic funds transfer (“EFT Payment”), you will be directed from the Employer Portal to a third-party electronic payment processing company’s website (“Online Payment Website”) to process your payment. Your payment via the Online Payment Website constitutes your agreement to be bound by the requirements and terms of the third-party electronic payment processing company and the terms and conditions of the Online Payment Website. You represent and warrant that you are authorized to make the EFT Payment. You are responsible for completing any requirements of your financial institution in order to send an EFT Payment to us. You are responsible for any losses in connection with any unauthorized interception or use of data relating to the EFT Payment, any inability to use or access the Online Payment Website for any reason, any actions or transactions by an individual who uses your banking information without your permission, and problems attributable to computer hardware or software (including computer viruses), telephone or other communications, or internet service providers.
To request a refund of a health care contribution already made to the San Francisco City Option Program, you must send us a written request that includes a signed statement verifying under penalty of perjury that sets forth the facts as to the basis for the refund and identifying the specific health care contributions sought to be refunded. Written requests for refunds may be sent to the address listed in Section Twenty (20) of the Terms and Conditions.
We will grant a refund of the health care contribution to you only if all of the following three circumstances are met:
- The health care contribution was submitted through the Employer Portal on or after September 2008;
- The refund request is due to one of the following mistakes:
- You mistakenly submitted a health care contribution through the Employer Portal for an employee who is not defined as a “Covered Employee” under the HSCO, or
- You mistakenly submitted a health care contribution through the Employer Portal for an employee who is exempt as a “Covered Employee” under the HCSO, or
You mistakenly submitted a health care contribution through the Employer Portal for a “Covered Employee” under the HCSO in excess of the minimum employer spending requirement;
- The health care contribution has not yet been applied for the employee’s benefit under one of the following scenarios:
Your health care contribution: (i) supported the employee’s enrollment into Healthy San Francisco based on preliminary eligibility, (ii) we mailed the employee information on how to enroll in Healthy San Francisco, and (iii) the employee has not yet enrolled in Healthy San Francisco; or
- Your health care contribution: (i) resulted in the establishment of an MRA and (ii) we have not yet mailed the employee with information about the establishment of the MRA and how to use the MRA.
If we approve your request for a refund of a health care contribution, a refund check will be sent to you by mail within twenty-one (21) business days of our written approval of your refund request. You must notify your employee who had received the health care contribution that the health care contribution was refunded to you and that the employee will no longer have access to the benefits arising out of the health care contribution that was refunded to you. We will send you a letter confirming that the refund has been made to you and a letter to your employee notifying the employee that the health care contribution was refunded to you.
11. Intellectual Property
"San Francisco City Option" and "City Option" are trademarks and service marks (collectively, “San Francisco City Option Marks”) owned by the San Francisco Department of Public Health. The Employer Portal and any content made available on the Employer Portal (other than data you submit to us) are owned and copyrighted by or licensed to the San Francisco Department of Public Health or others with all rights reserved unless otherwise noted. You do not, by virtue of downloading any content from the Employer Portal, obtain title to, or any other ownership interest in, that content. We do not permit your use of San Francisco City Option Marks in any manner, including advertising, as an endorsement for any product or service, in association with contests or promotions, or for any other purpose, commercial or otherwise, without our prior written approval.
12. Disclaimers of Warranty
INFORMATION ON THE EMPLOYER PORTAL AND SERVICES PROVIDED BY THE SAN FRANCISCO CITY OPTION PROGRAM ARE PROVIDED “AS IS.” ALL EXPRESS, IMPLIED, AND STATUTORY WARRANTIES, INCLUDING WITHOUT LIMITATION, THE WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, OR NON-INFRINGEMENT, ARE EXPRESSLY DISCLAIMED TO THE FULLEST EXTENT PERMITTED BY LAW. WE MAKE NO REPRESENTATION OR WARRANTIES TO YOU REGARDING THE LEVEL OR QUALITY OF OUR SERVICES.
WE DISCLAIM ANY WARRANTIES CONCERNING THE SECURITY, RELIABILITY, AND PERFORMANCE OF THE EMPLOYER PORTAL, AND THE ACCURACY OF THE INFORMATION CONTAINED IN THE EMPLOYER PORTAL. WE DISCLAIM RESPONSIBILITY FOR ANY HARM RESULTING FROM DOWNLOADING OR ACCESSING ANY INFORMATION OR MATERIALS THROUGH THE EMPLOYER PORTAL, INCLUDING WITHOUT LIMITATION, HARM CAUSED BY VIRUSES OR SIMILAR DESTRUCTIVE PROPERTIES. YOUR USE OF THE EMPLOYER PORTAL IS AT YOUR OWN RISK. WE DO NOT WARRANT THAT THE EMPLOYER PORTAL OR OUR SERVICES WILL MEET YOUR REQUIREMENTS OR THAT THE OPERATION OF THE EMPLOYER PORTAL OR OUR SERVICES WILL BE UNINTERRUPTED OR ERROR-FREE.
13. Limitation of Liability
TO THE MAXIMUM EXTENT PERMITTED BY LAW, IN NO EVENT WILL COMPANY BE LIABLE FOR DAMAGES OF ANY KIND (INCLUDING, BUT NOT LIMITED TO, SPECIAL, INCIDENTAL, OR CONSEQUENTIAL DAMAGES, LOST PROFITS, OR LOST DATA, REGARDLESS OF THE FORESEEABILITY OF THOSE DAMAGES) ARISING OUT OF OR IN CONNECTION WITH YOUR USE OF THE EMPLOYER PORTAL OR ANY OTHER SERVICES PROVIDED TO YOU BY THE SAN FRANCISCO CITY OPTION PROGRAM. THIS LIMITATION APPLIES REGARDLESS OF WHETHER THE DAMAGES ARISE OUT OF BREACH OF CONTRACT, TORT, OR ANY OTHER LEGAL THEORY OR FORM OF ACTION.
WE ARE NOT RESPONSIBLE OR LIABLE FOR THE ACTS OR OMISSIONS OF OUTSIDE VENDORS OR INFORMATION PROVIDERS, OR FOR PERFORMANCE (OR NON-PERFORMANCE) WITHIN OUTSIDE NETWORKS OR INTERCONNECTION POINTS BETWEEN THE EMPLOYER PORTAL AND OTHER NETWORKS AND/OR SITES THAT ARE OPERATED BY THIRD PARTIES.
14. Links To/From Third-Party Websites
The Employer Portal may provide links to other websites not owned or controlled by the San Francisco City Option Program, San Francisco Health Plan, or the Department of Public Health (“Third-Party Websites”). We are not responsible for the availability of Third-Party Websites, the quality or accuracy of information presented on Third-Party Websites, or for any viruses or other damaging elements encountered in linking to Third-Party Websites. In addition, providing links to Third-Party Websites should not be interpreted as our endorsement or approval of the organizations sponsoring such websites or their products or services.
We are not responsible or liable for any material on Third-Party Websites that may contain links to the Employer Portal. We reserve the right to disable any unauthorized links to the Employer Portal or the framing of any content from the Employer Portal on Third-Party Websites.
We reserve the right to investigate suspected violations of the Terms and Conditions. If we become aware of possible violations, we may initiate an investigation that may include gathering information from you or any user involved and the complaining party, if any, and examination of other material. We may suspend the provision of our services temporarily, or we may permanently remove the material involved from our servers, provide warnings to you, or suspend or terminate your access to our services. We will determine what action will be taken in response to a violation on a case-by-case basis, and at our sole discretion. We will fully cooperate with legal authorities in investigating suspected violations of the law.
You agree to indemnify us for certain of your acts and omissions. You agree to indemnify, defend, and hold harmless us and our officers, directors, employees, consultants, agents, and representatives from any and all third party claims, losses, liability, damages, and/or costs (including reasonable attorney fees and costs) arising from your access to or use of the Employer Portal, your violation of the Terms and Conditions, or your infringement, or infringement by any other user of your account, of any intellectual property or other right of any person or entity.
17. Governing Law
The Terms and Conditions will be construed in accordance with and governed by the laws of the United States, the State of California, and the City and County of San Francisco, without reference to their rules regarding conflicts of law. You agree that any legal action or proceeding relating to the Employer Portal and our services must be brought exclusively in a federal or state court of competent jurisdiction sitting in San Francisco, California, and you hereby expressly and irrevocably consent to the jurisdiction and venue of such courts.
18. No Waiver; Severability
A waiver of any breach of any provision of the Terms and Conditions will not be deemed to be a waiver of any repetition of such breach or in any manner affect any other terms or conditions. In the event that any provision of the Terms and Conditions is held to be unenforceable, it will not affect the validity or enforceability of the remaining provisions and will be replaced by an enforceable provision that is the closest to the intention underlying the unenforceable provision.
19. Changes to the Terms and Conditions
We reserve the right, at our sole discretion, to modify the Terms and Conditions, at any time and without prior notice. If we modify the Terms and Conditions, we will post the modification on the Employer Portal or otherwise provide you with notice of the modification. It is your responsibility to check periodically for any changes we make to the Terms and Conditions. By continuing to use the Employer Portal or our services after any changes to the Terms and Conditions, you are indicating that you agree to be bound by the modified Terms and Conditions. If the modified Terms and Conditions are not acceptable to you, your only recourse is to cease using the Employer Portal and our services.
20. Questions; Comments
If you have any questions or comments regarding our Terms and Conditions, please contact us by mail:
San Francisco City Option Program
201 Third Street, 7th Floor
San Francisco, CA 94103
Or by email: email@example.com. Acknowledgement
BY ACCESSING THE EMPLOYER PORTAL AND USING OUR SERVICES, YOU ACKNOWLEDGE THAT YOU HAVE READ THESE TERMS AND CONDITIONS AND AGREE TO BE BOUND BY THEM.