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DATA RELEASE AUTHORIZATION

The employer consenting to this Data Release Authorization ("Employer") sponsors health benefits for its employees through an Individual Coverage Health Reimbursement Arrangement (ICHRA) administered by Venteur, Inc. ("Venteur"). Venteur is discontinuing its ICHRA administration services and is working with Thatch Health, Inc. ("Thatch") to offer its customers the ability to transition administration of Employer's ICHRA to Thatch with minimal disruption to Employer and its employees. In connection with that transition, Employer hereby authorizes and directs Venteur to release to Thatch the data described below.

Employer Data

  • Employer legal name, DBA, EIN, business type, and business address

  • Administrator contact name, title, and email address

  • ICHRA plan documents and compliance records

Employee and Dependent Data

  • Employee names, dates of birth, home addresses, email addresses, and phone numbers

  • Job titles, start dates, end dates (if applicable), and compensation

  • ICHRA allowances, employee classes, and allowance usage history

  • Healthcare plan enrollments, including plan names, premiums, coverage dates, and on/off-exchange status

  • Dependent names, relationships, dates of birth, and SSNs

Broker Data

  • Broker and affiliated brokerage names and contact information

  • Referral fee arrangements applicable to Employer

Other

  • Payroll connections and credentials to the extent available

  • Historical data pertaining to government healthcare reporting

  • Any other data reasonably necessary to effectuate the transition of Employer's ICHRA to Thatch, enroll or manage ICHRA participants' insurance plans, set up payroll connections, or as otherwise agreed by the parties

Employer understands that the data described above will be used solely to administer Employer's ICHRA through Thatch and will be handled in accordance with Thatch's and Venteur's applicable privacy policies. By signing below, the individual signing confirms that they are authorized and have the right to act on behalf of Employer and to provide this authorization on behalf of Employer and all individuals whose information is being released.