Consent to Share Enrollment Data

This Consent to Share Enrollee Data (this “Consent”) is entered into by and between [insert Consenting Party name] (“Consenting Party”, “you”, or “your”) and [insert Enrollify Client name] (“Company”) as of the date it is executed by you. RECITALS
  • You contract with Company for purposes of offering employment benefits to your employees;
  • You contract with [insert Benefit Administration System name] (“Ben Admin”) for Benefits Administratration to provide a software as a service portal for the administration of your employment benefit plan;
  • Company contracts with Enrollify, Inc. (“Enrollify”) for Enrollify to provide a software as a service platform which provides tools designed to assist Company’s cost containment strategies (the “Enrollify Services”);
  • Company wishes to have Ben Admin Provider share the data pertaining to your employees’ elections and enrollments in your employee benefit plan described in Schedule 1 hereto (“Enrollment Data”) with Enrollify via an API feed and to have Enrollify access, display, and analyze the Enrollment Data for Company in connection with Enrollify’s provision of the Enrollify Services to Company (the “Purpose”); and
  • In order to accomplish the foregoing, your consent is or may be required, and you wish to grant your consent for Ben Admin, Company, and Enrollify to use and disclose Enrollment Data among one another for the Purpose.
As such, you and Company agree as follows: CONSENT You hereby consent for and authorize the Enrollment Data to be used and disclosed among Ben Admin Provider, Enrollify, and Company for the Purpose pursuant to your agreements with Ben Admin Provider and Company and each of Ben Admin Provider’s and Company’s agreements with Enrollify. You may revoke the consent granted hereunder and terminate this Consent at any time and for any reason by providing written notice to Company at the address set forth in the signature block or such other address as Company may provide. Agreed
CONSENTING PARTY COMPANY
BY___________________BY___________________
Name:_________________Name:_________________
Title:__________________Title:__________________
Date:__________________Date:__________________
Address:________________
______________________
Address:________________
______________________
Schedule 1: Describe Enrollment Data to be shared with Benefit Admin System