Terms of Use

The Enough! Health member app (the “App”) is operated by Open Enrollment, Inc., trading as Enough! Health (“we”, “us”, “our”). By creating an account or using the App, you agree to these terms. If you do not agree, do not use the App.

Enough! Health is not a licensed insurer. Coverage products are subject to state approval. We administer and service health benefit arrangements; we do not underwrite insurance.

The App is available by invitation. You are eligible if you are enrolled in, or eligible to enrol in, an Open Enrollment health benefit arrangement — normally through an employer — and you are a resident of a state where we operate. It is intended for adults, and for enrolled dependents under 18 whose guardian has authorised their access.

• ·Give us accurate information, and keep it current. Much of what the App shows you, and much of what your plan pays, depends on it.
• ·Your account is yours alone. Keep your password and your device secure, and do not let anyone else use your account. Tell us promptly if you think someone has.
• ·If you add a family member, you are confirming you have the authority to act for them — as the subscriber, a parent, or a legal guardian.

The App lets you see and act on your own plan: your coverage and plan documents, your care events and claims, your accounts and balances, your bills, your appeals, your family’s enrollment, and posted prices for shoppable care.

It is not any of the following, and nothing in it should be read as such:

• ·Not medical advice. Health information in the App — including anything summarising your record or suggesting questions to ask — is for your information only. It does not diagnose, treat, or replace a conversation with a clinician. In an emergency, call your local emergency number.
• ·Not a coverage decision. What you see in the App does not approve, guarantee, or deny coverage or payment of any claim. Coverage is determined under your plan documents.
• ·Not insurance advice. A licensed advisor is available to you and will tell you when they are acting in that capacity. The App itself does not recommend a plan.
• ·Not a complete record.Your health record in the App is assembled from the sources available to us, and may be incomplete or lag behind your providers’ own records.

The App is a convenience, not the contract. Your benefits, exclusions, cost-sharing, appeal rights and deadlines are set by your plan documents and by applicable law. If anything in the App conflicts with those documents — a balance, a date, a benefit, a status — the documents control, and we will correct the App.

Posted prices in the App come from the facilities that publish them. We show you the prices we hold, which is not every price in your market. So:

• ·A posted price is not a quote and not an offer. It can be out of date, and the facility can change it.
• ·We do not claim any price is the cheapest available. The lowest number we hold is the lowest number we hold.
• ·A cash price is not necessarily what you will pay with your coverage, and the difference between two posted prices is a fact about those prices — not a promise of savings.
• ·What you finally owe is determined by the facility’s bill and your plan, after the care happens.

When you photograph or upload a bill, we read it to help you confirm what it says. You are responsible for the accuracy of what you confirm — including the amount, the date and who the care was for. Submitting a bill is a request; it is not approval, and it does not by itself cause a payment.

Do not submit documents that are not yours to submit, and do not submit anything you know to be false. Deliberately submitting false information may end your access to the App and may be reported where the law requires it.

Where your arrangement includes a payment card or a funded account, how it may be used, what it may be used for, and what happens to an unspent balance are set by your plan documents and by the issuer’s own terms — not by these terms. Balances shown in the App are informational and may not reflect transactions still in flight.

You can start an appeal in the App. Doing so does not extend any deadline in your plan documents or under law, and the outcome is decided under those documents and not by the App. Keep your own copy of anything you send us.

We will contact you about your plan, your enrollment, your appeals and anything we need from you — this is part of administering your benefits. You control optional push notifications in the App and in your device settings. Turning off a notification does not stop a communication we are required to send.

• ·Access only your own record, and the records of family members you are authorised to act for.
• ·Do not probe, scan, or try to break the App or our systems; do not attempt to reach another member’s data.
• ·Do not scrape, resell, or redistribute price data or any other content from the App.
• ·Do not upload malicious code, or content that is not yours to upload.

We may suspend or end access that puts members’ data, our systems, or our legal obligations at risk.

The App, its design and its content are ours or our licensors’, and these terms do not transfer any of that to you. What you put in — your information, your documents, your statements — stays yours. You give us the permission we need to host and process it in order to run the App and administer your benefits, as described in the Privacy Policy.

The App connects to services we do not control — your providers, a device partner you choose to connect, a facility’s own website, a mapping provider. Their terms and their privacy practices are their own. We are not responsible for what they do or for content they provide.

You can ask us to close your account from the App, or by emailing hello@joinenoughhealth.com. A person handles the request: someone on our team will go through what it means for your coverage and for the records we hold, and confirm with you before anything changes.

Closing your account is not the same as ending your coverage, and we will not treat it as though it were. Tell us which one you want. We keep records for as long as HIPAA and state insurance law require, as set out in the Privacy Policy, so closing an account does not erase everything immediately.

We improve the App continually, and features may change or be withdrawn. If we make a material change to these terms we will give you notice in the App or by email before it takes effect. If you keep using the App after that, you are accepting the updated terms. For a prior version, email hello@joinenoughhealth.com.

We work to keep the App accurate and available, but we do not promise it will be uninterrupted or error-free, and we do not promise that every figure in it is current at the moment you read it. Except where the law does not allow us to, the App is provided “as is”, without warranties of any kind.

Nothing here limits any right you have under your plan documents, under HIPAA, or under the insurance and consumer-protection laws of your state.

To the extent the law allows, we are not liable for indirect or consequential loss arising from your use of the App, and our total liability relating to the App is limited to the amount you paid us, if any, for access to it. This does not limit liability that cannot be limited by law, and it does not affect claims for benefits, which are governed by your plan documents and the processes in them.

Questions about these terms: hello@joinenoughhealth.com.

See also the Privacy Policy and the Help Centre.