1. [Acceptance of Terms](#acceptance-of-terms) 2. [Definitions](#definitions) 3. [Scope and Application](#scope-and-application) 4. [User Registration and Account Security](#user-registration-and-account-security) 5. [Privacy and HIPAA Compliance](#privacy-and-hipaa-compliance) 6. [Medical Information Disclaimer](#medical-information-disclaimer) 7. [User Obligations and Responsibilities](#user-obligations-and-responsibilities) 8. [Prohibited Uses and Restrictions](#prohibited-uses-and-restrictions) 9. [Intellectual Property Rights](#intellectual-property-rights) 10. [Security and Data Protection](#security-and-data-protection) 11. [Third-Party Services and Business Associates](#third-party-services-and-business-associates) 12. [Limitation of Liability](#limitation-of-liability) 13. [Disclaimer of Warranties](#disclaimer-of-warranties) 14. [Indemnification](#indemnification) 15. [Modifications to Terms](#modifications-to-terms) 16. [Termination and Suspension](#termination-and-suspension) 17. [Governing Law and Jurisdiction](#governing-law-and-jurisdiction) 18. [Contact Information](#contact-information) 19. [Severability](#severability) 20. [Entire Agreement](#entire-agreement)
Welcome to Evertrust Health Insurance's health insurance website and related digital services. These Terms of Service ("Terms," "Agreement," or "Terms of Service") constitute a legally binding agreement between you ("User," "you," or "your") and Evertrust Health Insurance ("Company," "we," "us," or "our") regarding your access to and use of our website, mobile applications, online portals, and any related services (collectively, the "Services").
By accessing, browsing, or using our Services in any manner, you acknowledge that you have read, understood, and agree to be bound by these Terms of Service and all applicable laws and regulations. If you do not agree to these terms, you are not authorized to use our Services and must discontinue use immediately.
These Terms of Service apply to all users of our Services, including but not limited to current policyholders, prospective customers, healthcare providers, brokers, agents, and any other individuals who access our digital platforms. Your use of our Services constitutes acceptance of these terms regardless of whether you have created an account or registered for specific services.
The agreement formed by these Terms of Service is equivalent to a written contract signed by both parties. By continuing to use our Services after any modifications to these Terms, you agree to be bound by such modifications. If you do not agree to any changes, your sole remedy is to discontinue use of our Services.
These Terms of Service supplement and do not replace any separate agreements you may have with us regarding insurance coverage, healthcare services, or other business relationships. In the event of any conflict between these Terms of Service and such separate agreements, the separate agreements shall control with respect to the specific subject matter covered therein.
For purposes of these Terms of Service, the following terms shall have the meanings set forth below:
"Business Associate" means any person or entity that performs certain functions or activities on behalf of the Company that involve the use or disclosure of Protected Health Information, as defined under HIPAA regulations. "Company" refers to Evertrust Health Insurance, a health insurance company organized under the laws of South Carolina, and includes its subsidiaries, affiliates, successors, and assigns. "Covered Entity" means the Company in its capacity as a health plan subject to HIPAA Privacy, Security, and Breach Notification Rules. "HIPAA" means the Health Insurance Portability and Accountability Act of 1996, as amended, and its implementing regulations, including the Privacy Rule (45 CFR Part 160 and Part 164, Subparts A and E), the Security Rule (45 CFR Part 164, Subparts A and C), and the Breach Notification Rule (45 CFR Part 164, Subparts A and D). "Member Portal" refers to the secure, password-protected areas of our Services that provide registered users with access to personal health information, insurance benefits, claims information, and other confidential data. "Personal Information" means any information that identifies, relates to, describes, or is capable of being associated with a particular individual, including but not limited to name, address, telephone number, email address, social security number, and financial information. "Protected Health Information" or "PHI" means individually identifiable health information that is transmitted or maintained in any form or medium by the Company as a Covered Entity, as defined under HIPAA regulations. "Services" means all websites, mobile applications, online portals, digital tools, and related services provided by the Company, including but not limited to informational content, member portals, claims processing systems, and customer service platforms. "User" means any individual who accesses or uses our Services, including current and former policyholders, prospective customers, healthcare providers, authorized representatives, and any other persons granted access to our digital platforms. "User Content" means any information, data, text, photographs, graphics, or other materials uploaded, submitted, or transmitted by users through our Services.
These definitions are provided for clarity and legal precision. Additional terms may be defined within specific sections of these Terms of Service as needed for context and understanding.
These Terms of Service govern your access to and use of all digital services provided by Evertrust Health Insurance, including our primary website, mobile applications, member portals, online tools, and any other digital platforms we operate or maintain. The scope of these Terms extends to all interactions with our digital infrastructure, whether accessed directly or through third-party integrations.
3.1 Covered Services
Our Services encompass a comprehensive range of digital offerings designed to support our health insurance operations and serve our members, providers, and other stakeholders. These Services include:
Public Website Areas: General informational content about our insurance products, services, company information, educational resources, and publicly accessible tools such as provider directories and plan comparison utilities. Member Portal Systems: Secure, authenticated areas providing registered users access to personal health information, insurance benefits details, claims history, explanation of benefits documents, ID card access, and account management functions. Mobile Applications: Native and web-based mobile applications that provide access to member services, provider tools, and other functionalities optimized for mobile devices. Provider Portals: Specialized platforms designed for healthcare providers, including claim submission systems, prior authorization tools, member eligibility verification, and provider resource centers. Customer Service Platforms: Digital customer service tools including live chat systems, automated assistance features, online forms, and support ticket systems.
3.2 Regulatory Compliance Framework
As a health insurance company operating as a Covered Entity under HIPAA, our Services are designed and operated in compliance with applicable federal and state regulations governing health information privacy and security. These Terms of Service are structured to ensure compliance with:
The Health Insurance Portability and Accountability Act (HIPAA) and its implementing regulations, which establish national standards for the protection of individually identifiable health information and grant patients rights over their health information.
State insurance regulations and consumer protection laws that govern health insurance operations, marketing practices, and consumer rights within the jurisdictions where we operate.
Federal healthcare regulations including those established by the Centers for Medicare & Medicaid Services (CMS), the Department of Health and Human Services (HHS), and other relevant regulatory bodies.
3.3 Relationship to Other Agreements
These Terms of Service operate in conjunction with, but do not replace, other legal agreements and documents that govern your relationship with our Company. Your insurance policy documents, including certificates of coverage, summary plan descriptions, and benefit schedules, remain the primary source of information regarding your insurance coverage and benefits.
Our Privacy Notice, which is incorporated by reference into these Terms, provides detailed information about how we collect, use, and protect your personal and health information in compliance with HIPAA and other applicable privacy laws.
Business Associate Agreements with third-party service providers establish additional protections for Protected Health Information and ensure that our vendors maintain appropriate safeguards when handling health information on our behalf.
3.4 Geographic and Jurisdictional Scope
These Terms of Service apply to users accessing our Services from any location, but the availability of specific services and features may vary based on geographic location, regulatory requirements, and business operations. Certain services may be restricted to users within specific states or regions where we are licensed to conduct insurance business.
Users accessing our Services from outside the United States acknowledge that our Services are operated from within the United States and that their use of our Services may be subject to United States laws and regulations, including those governing the export of data and technology.
Access to certain areas of our Services, particularly those containing Protected Health Information or personal account details, requires user registration and authentication. This section establishes the requirements, responsibilities, and security measures associated with user accounts and access credentials.
4.1 Registration Requirements
To access secure areas of our Services, including Member Portals and provider-specific platforms, you must complete our registration process and create user credentials. Registration requires you to provide accurate, current, and complete information as prompted by our registration forms.
Identity Verification: As a health insurance company handling sensitive health and financial information, we implement robust identity verification procedures. You may be required to provide personal identifying information including your full legal name, date of birth, social security number, policy or member identification number, and other information necessary to verify your identity and eligibility for access. Contact Information: You must provide current and accurate contact information, including a valid email address and telephone number. This information is essential for account security notifications, important communications regarding your coverage, and compliance with regulatory notification requirements. Eligibility Confirmation: Access to member-specific information and services is limited to eligible individuals, including policyholders, covered dependents, authorized representatives, and healthcare providers with appropriate authorization. You represent and warrant that you are eligible for the level of access you are requesting.
4.2 Account Security Responsibilities
You are solely responsible for maintaining the confidentiality and security of your account credentials, including usernames, passwords, security questions, and any other authentication factors. This responsibility extends to all activities that occur under your account, whether authorized by you or not.
Password Security: You must create strong passwords that meet our security requirements and must not share your password with any other person or entity. Passwords should be unique to your account with our Services and should not be reused from other online accounts. Account Monitoring: You are responsible for monitoring your account for unauthorized access or suspicious activity. You must notify us immediately of any suspected security breach, unauthorized access, or suspected misuse of your account credentials. Authorized Access Only: You may only access information and services for which you are specifically authorized. Members may only access their own health information and account details, while healthcare providers may only access information for patients under their care and with appropriate authorization.
4.3 Multi-Factor Authentication
Given the sensitive nature of health information and the regulatory requirements governing its protection, we may implement multi-factor authentication (MFA) for access to certain Services. MFA may include combinations of passwords, security tokens, biometric verification, SMS verification codes, or other authentication methods.
When MFA is enabled, you are responsible for maintaining access to all required authentication factors. Loss of access to authentication factors may result in temporary account lockout until identity can be re-verified through our established procedures.
4.4 Account Suspension and Termination
We reserve the right to suspend or terminate user accounts under various circumstances to protect the security of our Services and comply with legal and regulatory requirements.
Security-Based Suspension: Accounts may be temporarily suspended if we detect suspicious activity, multiple failed login attempts, or other indicators of potential security compromise. Suspended accounts will be restored once identity is re-verified and security concerns are resolved. Compliance-Based Termination: Accounts may be terminated if users violate these Terms of Service, engage in fraudulent activity, or use our Services in ways that violate applicable laws or regulations. Administrative Termination: We may terminate accounts when users are no longer eligible for access, such as when insurance coverage ends or when healthcare providers no longer have authorized relationships with covered members.
4.5 Data Retention and Account Closure
When accounts are closed or terminated, we will handle associated data in accordance with our Privacy Notice, applicable legal requirements, and regulatory retention schedules. Some information may be retained for legal, regulatory, or business purposes even after account closure.
Users may request account closure by contacting our customer service department. Account closure does not automatically terminate insurance coverage or other business relationships, which are governed by separate agreements and procedures.
As a Covered Entity under the Health Insurance Portability and Accountability Act (HIPAA), Evertrust Health Insurance is committed to protecting the privacy and security of your Protected Health Information (PHI) and Personal Information. This section outlines our privacy practices, your rights regarding your health information, and our compliance with applicable privacy and security regulations.
5.1 HIPAA Compliance Framework
Our Services are designed and operated in full compliance with HIPAA Privacy, Security, and Breach Notification Rules. As a health plan and Covered Entity, we are legally required to protect your PHI and provide you with certain rights regarding your health information.
Privacy Rule Compliance: We comply with the HIPAA Privacy Rule (45 CFR Parts 160 and 164, Subparts A and E), which establishes national standards for the protection of individually identifiable health information. This includes implementing appropriate administrative, physical, and technical safeguards to protect PHI from unauthorized access, use, or disclosure. Security Rule Compliance: Our digital Services implement the administrative, physical, and technical safeguards required by the HIPAA Security Rule (45 CFR Part 164, Subparts A and C) to ensure the confidentiality, integrity, and availability of electronic PHI (ePHI). Breach Notification Compliance: In the event of a breach of unsecured PHI, we will provide notifications as required by the HIPAA Breach Notification Rule (45 CFR Part 164, Subparts A and D) to affected individuals, the Department of Health and Human Services, and, in certain cases, the media.
5.2 Privacy Notice Integration
Our Privacy Notice, which is incorporated by reference into these Terms of Service, provides detailed information about our privacy practices, including:
How we collect, use, and disclose your PHI and Personal Information in connection with treatment, payment, healthcare operations, and other permitted or required purposes under HIPAA and applicable state laws.
Your individual rights regarding your health information, including the right to access, amend, restrict, and request an accounting of disclosures of your PHI.
Our legal obligations regarding the protection of your health information and the circumstances under which we may be required or permitted to disclose PHI without your authorization.
The procedures for filing complaints regarding our privacy practices and your rights under HIPAA.
5.3 Permitted Uses and Disclosures
We may use and disclose your PHI for the following purposes without your written authorization, as permitted or required by HIPAA and applicable state laws:
Treatment: We may disclose your PHI to healthcare providers involved in your care to facilitate treatment decisions, care coordination, and continuity of care. Payment: We may use and disclose your PHI for payment activities, including determining eligibility for benefits, processing claims, conducting utilization review, and other payment-related functions. Healthcare Operations: We may use and disclose your PHI for healthcare operations, including quality assessment and improvement activities, case management, care coordination, fraud and abuse detection, and business planning and development. Required by Law: We may disclose your PHI when required by federal, state, or local law, including disclosures for public health activities, health oversight activities, judicial and administrative proceedings, and law enforcement purposes.
5.4 Individual Rights Under HIPAA
As an individual whose PHI is maintained by our Company, you have the following rights under HIPAA:
Right of Access: You have the right to inspect and obtain copies of your PHI maintained in our designated record sets, subject to certain limitations and procedures established by HIPAA. Right to Amend: You have the right to request amendments to your PHI if you believe the information is inaccurate or incomplete. Right to Restrict: You have the right to request restrictions on our use and disclosure of your PHI for treatment, payment, or healthcare operations, though we are not required to agree to all requested restrictions. Right to Alternative Communications: You have the right to request that we communicate with you about your PHI through alternative means or at alternative locations. Right to an Accounting: You have the right to request an accounting of certain disclosures of your PHI that we have made for purposes other than treatment, payment, or healthcare operations.
5.5 Website-Specific Privacy Considerations
Our digital Services implement additional privacy protections specific to online environments:
Secure Transmission: All transmission of PHI through our Services is encrypted using industry-standard encryption protocols to protect information in transit. Session Management: User sessions in secure areas of our Services are automatically terminated after periods of inactivity to prevent unauthorized access to PHI. Access Logging: We maintain audit logs of access to PHI through our digital Services to monitor for unauthorized access and ensure accountability. Cookie and Tracking Technology: Our use of cookies, web beacons, and other tracking technologies is governed by our Privacy Notice and is designed to enhance user experience while maintaining appropriate privacy protections.
5.6 Business Associate Relationships
When we engage third-party service providers who may have access to PHI in connection with services provided to us, we enter into Business Associate Agreements (BAAs) that require these providers to implement appropriate safeguards to protect PHI and comply with applicable HIPAA requirements.
Users should be aware that certain features of our Services may involve the transmission of PHI to Business Associates for purposes such as claims processing, customer service, technical support, or data analysis. All such transmissions are governed by appropriate BAAs and are conducted in compliance with HIPAA requirements.
The information and services provided through our digital platforms are designed to support your healthcare and insurance needs, but they do not constitute medical advice, diagnosis, or treatment. This section establishes important limitations and disclaimers regarding the medical information available through our Services.
6.1 No Medical Advice or Treatment
Informational Purposes Only: All health-related information, educational content, wellness resources, and medical information provided through our Services are for informational and educational purposes only. This information is not intended as a substitute for professional medical advice, diagnosis, or treatment from qualified healthcare providers. No Doctor-Patient Relationship: Your use of our Services does not establish a doctor-patient relationship, healthcare provider-patient relationship, or any other professional healthcare relationship between you and Evertrust Health Insurance, our employees, contractors, or affiliated healthcare providers. We are a health insurance company, not a healthcare provider, and our Services are designed to support insurance-related functions rather than provide medical care. Professional Medical Consultation Required: You should always consult with qualified healthcare professionals regarding any medical questions, symptoms, conditions, or treatment decisions. Never disregard professional medical advice or delay seeking medical treatment because of information you have accessed through our Services.
6.2 Health Information Accuracy and Currency
While we strive to provide accurate and up-to-date health information, medical knowledge and best practices evolve continuously. The health information available through our Services may not reflect the most current medical research, treatment guidelines, or clinical recommendations.
No Warranty of Accuracy: We make no representations or warranties regarding the accuracy, completeness, currency, or reliability of any health information provided through our Services. Medical information is provided "as is" without warranty of any kind. Individual Medical Circumstances: Health information provided through our Services is general in nature and may not be applicable to your specific medical circumstances, health conditions, or treatment needs. Individual medical situations require personalized evaluation by qualified healthcare professionals.
6.3 Emergency Medical Situations
Emergency Disclaimer: Our Services are not designed for use in emergency medical situations. If you are experiencing a medical emergency, you should immediately call 911, contact your local emergency services, or go to the nearest emergency room. Do not use our Services to seek emergency medical assistance or to communicate urgent medical needs. Response Time Limitations: Our customer service and member support functions are not equipped to provide immediate responses to urgent medical questions or emergencies. Response times for inquiries submitted through our Services may vary and are not appropriate for time-sensitive medical situations.
6.4 Prescription Drug and Treatment Information
Information about prescription drugs, medical devices, treatments, and procedures available through our Services is provided for educational purposes and to help you understand your insurance coverage. This information should not be used to make decisions about medication use, treatment options, or medical care without consulting with your healthcare providers.
Coverage vs. Medical Appropriateness: Information about insurance coverage for specific drugs, treatments, or procedures does not constitute a recommendation for their use or an indication of their medical appropriateness for your specific condition. Coverage decisions are based on insurance policy terms and medical necessity criteria, not on medical advice or treatment recommendations. Drug Interaction and Safety Information: While our Services may provide general information about prescription drugs, including potential side effects and interactions, this information is not comprehensive and should not be relied upon for making decisions about medication use. Always consult with your pharmacist or healthcare provider regarding drug interactions, side effects, and safety considerations.
6.5 Mental Health and Crisis Resources
If our Services include mental health resources or information, please be aware that these resources are educational in nature and do not constitute mental health treatment or crisis intervention services.
Crisis Situations: If you are experiencing a mental health crisis or having thoughts of self-harm, please contact the National Suicide Prevention Lifeline at 988, call 911, or go to your nearest emergency room immediately. Our Services are not equipped to provide crisis intervention or immediate mental health support. Professional Mental Health Care: Mental health information provided through our Services should not replace professional mental health care from qualified mental health providers. If you are seeking mental health treatment, please contact a licensed mental health professional or your healthcare provider.
6.6 Wellness and Preventive Care Information
Wellness programs, health assessments, preventive care recommendations, and lifestyle information provided through our Services are general in nature and may not be appropriate for all individuals. Before beginning any wellness program or making significant changes to your diet, exercise routine, or lifestyle, you should consult with your healthcare provider.
Individual Health Assessment: Wellness tools and health risk assessments available through our Services provide general information based on the data you provide, but they do not constitute medical evaluations or diagnoses. Results from these tools should be discussed with your healthcare provider for proper interpretation and follow-up care.
6.7 Third-Party Health Information
Our Services may include links to third-party websites, applications, or resources that provide health information. We do not endorse, control, or assume responsibility for the accuracy, completeness, or reliability of health information provided by third parties. Your use of third-party health resources is at your own risk and subject to the terms and privacy policies of those third parties.
As a user of our Services, you have certain obligations and responsibilities that are essential for maintaining the security, integrity, and proper functioning of our digital platforms. This section outlines your duties and responsibilities when accessing and using our Services.
7.1 Compliance with Laws and Regulations
You are required to comply with all applicable federal, state, and local laws and regulations in connection with your use of our Services. This includes, but is not limited to:
Healthcare Laws: Compliance with healthcare-related laws and regulations, including HIPAA, state privacy laws, and regulations governing the use and disclosure of health information. Insurance Regulations: Adherence to insurance laws and regulations, including those prohibiting insurance fraud, misrepresentation, and other unlawful activities related to insurance coverage and claims. Computer and Internet Laws: Compliance with laws governing computer use, internet activities, data protection, and electronic communications, including the Computer Fraud and Abuse Act and applicable state computer crime laws. Export Control Laws: If you access our Services from outside the United States, you are responsible for complying with applicable export control laws and regulations.
7.2 Accurate Information and Truthful Representations
You are required to provide accurate, current, and complete information when using our Services, including when registering for accounts, submitting claims, updating personal information, or communicating with our customer service representatives.
Identity Verification: You must provide truthful information about your identity and eligibility for services. Misrepresentation of identity or eligibility may result in account termination and may constitute fraud. Contact Information: You must maintain current contact information, including email addresses and telephone numbers, to ensure you receive important communications regarding your coverage and account. Health Information Accuracy: When providing health information through our Services, including information for claims processing or health assessments, you must ensure the information is accurate and complete to the best of your knowledge.
7.3 Account Security and Access Control
You are solely responsible for maintaining the security of your account credentials and for all activities that occur under your account. This responsibility includes:
Credential Protection: Safeguarding your username, password, security questions, and any other authentication factors. You must not share your credentials with any other person or allow unauthorized access to your account. Authorized Use Only: Using your account only for authorized purposes and accessing only information and services for which you have proper authorization. Members may only access their own health information, and healthcare providers may only access information for patients under their care. Security Monitoring: Monitoring your account for suspicious activity and reporting any suspected unauthorized access or security breaches immediately to our customer service department. Session Management: Properly logging out of secure areas of our Services when finished, especially when using shared or public computers.
7.4 Appropriate Use of Services
You must use our Services in a manner that is consistent with their intended purpose and in accordance with these Terms of Service. Appropriate use includes:
Legitimate Business Purposes: Using our Services for legitimate insurance-related purposes, such as accessing your benefits information, submitting claims, finding healthcare providers, or obtaining customer service support. Respectful Communication: Communicating respectfully and professionally when interacting with our customer service representatives, using our messaging systems, or participating in any community features. Resource Conservation: Using our Services in a manner that does not place excessive demands on our systems or interfere with other users' ability to access and use the Services.
7.5 Protection of Confidential Information
When using our Services, you may have access to confidential information, including your own PHI and other sensitive data. You are responsible for protecting this information and using it appropriately.
PHI Protection: If you are accessing PHI through our Services, whether your own or that of family members for whom you are an authorized representative, you must protect this information from unauthorized disclosure and use it only for appropriate purposes. Third-Party Information: You must not attempt to access information belonging to other users or members, and you must report any inadvertent access to such information to our customer service department immediately. Information Sharing: You should exercise caution when sharing information obtained through our Services and should only share such information with authorized individuals who have a legitimate need to know.
7.6 Reporting Obligations
You have certain obligations to report issues, concerns, or violations that you become aware of while using our Services:
Security Incidents: You must report any suspected security breaches, unauthorized access, or suspicious activity related to your account or our Services. Technical Problems: You should report technical problems, errors, or malfunctions that interfere with the proper functioning of our Services. Privacy Violations: You must report any suspected violations of privacy or unauthorized access to PHI that you become aware of. Terms of Service Violations: You should report any violations of these Terms of Service by other users that you observe.
7.7 Cooperation with Investigations
You agree to cooperate with any investigations conducted by the Company, regulatory authorities, or law enforcement agencies related to your use of our Services or any suspected violations of law or these Terms of Service.
Information Provision: You may be required to provide information, documentation, or testimony related to your use of our Services or any incidents involving our Services. Access Preservation: You agree not to destroy, alter, or conceal any information that may be relevant to an investigation, and you will preserve such information as requested by appropriate authorities.
7.8 Compliance Monitoring
We reserve the right to monitor your use of our Services to ensure compliance with these Terms of Service, applicable laws and regulations, and our internal policies and procedures. This monitoring may include:
Access Logging: Recording and reviewing access to PHI and other sensitive information to ensure appropriate use and detect unauthorized access. Communication Monitoring: Monitoring communications through our Services, including customer service interactions and messages, for quality assurance and compliance purposes. Usage Analysis: Analyzing usage patterns to identify potential security threats, fraud, or violations of these Terms of Service.
Your continued use of our Services constitutes consent to such monitoring activities, which are conducted in accordance with applicable laws and our Privacy Notice.
To protect the security, integrity, and proper functioning of our Services, and to comply with applicable laws and regulations, certain uses of our Services are strictly prohibited. This section outlines activities that are not permitted and may result in account suspension, termination, or legal action.
8.1 Unauthorized Access and Security Violations
You may not engage in any activities that compromise or attempt to compromise the security of our Services, including:
Unauthorized Access Attempts: Attempting to gain unauthorized access to our Services, other user accounts, computer systems, or networks connected to our Services through hacking, password mining, or any other means. Security Circumvention: Bypassing, disabling, or otherwise circumventing any security measures, access controls, or authentication mechanisms implemented in our Services. System Interference: Engaging in any activity that disrupts, impairs, or interferes with the performance, functionality, or availability of our Services or the underlying infrastructure. Malicious Code: Introducing, uploading, or transmitting any viruses, worms, Trojan horses, spyware, malware, or other malicious code or harmful components through our Services. Network Attacks: Conducting or attempting to conduct any form of network attack, including denial-of-service attacks, distributed denial-of-service attacks, or other attacks designed to disrupt our Services.
8.2 Data Mining and Automated Access
Given the sensitive nature of health information and the importance of protecting our members' privacy, certain automated and bulk data collection activities are strictly prohibited:
Automated Data Collection: Using robots, crawlers, scrapers, spiders, or other automated means to access, collect, or extract data from our Services without our express written permission. Data Mining and Harvesting: Systematically collecting, compiling, or aggregating data from our Services, whether manually or through automated means, for any purpose other than your individual, personal use of the Services. Artificial Intelligence Training: Using any data, content, or information obtained from our Services to develop, train, or enhance artificial intelligence models, machine learning algorithms, large language models, or other AI technologies without our express written consent. Bulk Data Processing: Processing large volumes of data from our Services using artificial intelligence tools, machine learning capabilities, or other automated processing technologies for purposes other than your individual use of the Services. Screen Scraping: Using any technology or method to extract, copy, or collect information displayed on our Services for purposes other than your personal use of the Services.
8.3 Misuse of Health Information
The misuse of health information accessed through our Services is strictly prohibited and may violate federal and state laws:
Unauthorized PHI Access: Attempting to access Protected Health Information belonging to other individuals, including family members, unless you are specifically authorized to access such information as a personal representative or authorized user. PHI Disclosure Violations: Disclosing PHI obtained through our Services to unauthorized individuals or using such information for purposes other than those permitted under HIPAA and applicable state laws. Identity Misrepresentation: Misrepresenting your identity or relationship to a member in order to gain unauthorized access to health information or insurance benefits. Fraudulent Claims: Submitting false, fraudulent, or misleading information in connection with insurance claims, benefit applications, or other insurance-related activities.
8.4 Commercial and Unauthorized Uses
Our Services are intended for personal use by our members, healthcare providers, and other authorized users. Commercial exploitation and unauthorized business uses are prohibited:
Commercial Exploitation: Using our Services for commercial purposes, including advertising, marketing, or promoting products or services, without our express written permission. Resale or Distribution: Reselling, redistributing, or providing access to our Services to third parties, or using our Services as part of a service bureau or outsourcing arrangement. Competitive Intelligence: Using our Services to gather competitive intelligence or to develop competing products or services. Unauthorized Business Use: Using our Services for business purposes other than those specifically authorized, such as using member portals for purposes other than managing your own insurance coverage.
8.5 Intellectual Property Violations
You may not use our Services in ways that violate intellectual property rights:
Copyright Infringement: Copying, reproducing, distributing, or creating derivative works from copyrighted content available through our Services without proper authorization. Trademark Misuse: Using our trademarks, service marks, logos, or other proprietary marks without our express written permission or in ways that may cause confusion about the source or sponsorship of goods or services. Reverse Engineering: Reverse engineering, decompiling, disassembling, or otherwise attempting to derive the source code, underlying algorithms, or proprietary methods used in our Services. Content Modification: Removing, altering, or obscuring any copyright, trademark, or other proprietary notices, terms, or disclosures associated with our Services or content.
8.6 Harmful or Illegal Activities
You may not use our Services to engage in or facilitate harmful or illegal activities:
Illegal Activities: Using our Services to engage in, facilitate, or promote any illegal activities or violations of applicable laws or regulations. Harassment or Abuse: Using our Services to harass, threaten, intimidate, or abuse other users, our employees, or any other individuals. Fraudulent Activities: Engaging in any fraudulent activities, including insurance fraud, identity theft, or financial fraud, through or in connection with our Services. Harmful Content: Uploading, transmitting, or sharing content that is harmful, offensive, defamatory, or inappropriate through our Services.
8.7 System Abuse and Resource Misuse
To ensure fair access and optimal performance for all users, certain uses that abuse system resources are prohibited:
Excessive Resource Use: Using our Services in ways that place excessive demands on our systems, consume excessive bandwidth, or interfere with other users' ability to access and use the Services. Multiple Account Creation: Creating multiple accounts for the same individual or entity without authorization, or creating accounts using false or misleading information. Automated Interactions: Using automated systems or scripts to interact with our Services in ways that simulate human activity or generate excessive requests.
8.8 Enforcement and Consequences
Violations of these prohibited uses and restrictions may result in various enforcement actions:
Account Suspension: Temporary suspension of access to our Services while violations are investigated and resolved. Account Termination: Permanent termination of access to our Services for serious or repeated violations. Legal Action: Pursuit of legal remedies, including civil litigation and cooperation with law enforcement agencies, for violations that constitute criminal activity or cause significant harm. Regulatory Reporting: Reporting of violations to appropriate regulatory authorities when required by law or when violations involve regulated activities such as insurance fraud.
We reserve the right to investigate suspected violations of these restrictions and to take appropriate action to protect our Services, our members, and our business operations. Users who violate these restrictions may also be liable for damages and may be subject to criminal prosecution under applicable laws.
All content, materials, and intellectual property associated with our Services are owned by Evertrust Health Insurance or our licensors and are protected by applicable intellectual property laws. This section establishes the ownership rights and usage restrictions related to our intellectual property.
9.1 Company Ownership Rights
Website Content: All content available through our Services, including but not limited to text, graphics, images, logos, photographs, audio, video, software, data compilations, and the overall design and appearance of our Services, is owned by Evertrust Health Insurance or our licensors and is protected by United States and international copyright laws. Trademarks and Service Marks: Our company name, logos, trademarks, service marks, and trade names, including Evertrust Health Insurance and related marks, are the exclusive property of Evertrust Health Insurance. The Blue Cross and Blue Shield marks and symbols, if applicable, are registered service marks of the Blue Cross and Blue Shield Association and are used under license. Proprietary Systems: The software, systems, processes, and methodologies used to operate our Services, including our member portals, claims processing systems, and other proprietary technologies, are the exclusive property of Evertrust Health Insurance and are protected by copyright, trade secret, and other intellectual property laws. Data and Compilations: Compilations of data, member information, provider networks, and other information databases maintained through our Services are proprietary to Evertrust Health Insurance and are protected as collective works and compilations under applicable copyright laws.
9.2 Limited License to Users
Subject to your compliance with these Terms of Service, we grant you a limited, non-exclusive, non-transferable, revocable license to access and use our Services solely for your personal, non-commercial use in accordance with these Terms.
Scope of License: This license permits you to view, access, and use our Services for legitimate insurance-related purposes, including managing your insurance coverage, accessing your health information, and utilizing customer service features. Restrictions on Use: You may not copy, modify, distribute, sell, lease, rent, or create derivative works from any content or materials available through our Services without our express written permission. You may not use our content for commercial purposes or in any manner that competes with our business operations. Termination of License: This license automatically terminates if you violate these Terms of Service or if your access to our Services is terminated for any reason. Upon termination, you must cease all use of our Services and destroy any downloaded or printed materials.
9.3 User-Generated Content
When you submit, upload, or transmit content through our Services, including messages, documents, images, or other materials, you retain ownership of such content but grant us certain rights to use and process such content.
License Grant: By submitting content through our Services, you grant Evertrust Health Insurance a non-exclusive, royalty-free, worldwide license to use, copy, modify, and distribute such content solely for the purposes of providing our Services, processing your requests, and complying with legal and regulatory requirements. Content Responsibility: You are solely responsible for any content you submit through our Services and represent that you have all necessary rights to grant the license described above. You warrant that your content does not violate any third-party rights or applicable laws. Content Monitoring: We reserve the right to monitor, review, and remove any user-generated content that violates these Terms of Service, applicable laws, or our content policies.
9.4 Third-Party Intellectual Property
Our Services may include content, materials, or links provided by third parties, including healthcare providers, pharmaceutical companies, and other business partners.
Third-Party Rights: Third-party content remains the property of its respective owners and is used under appropriate licenses or permissions. We do not claim ownership of third-party content and respect the intellectual property rights of others. License Compliance: Your use of third-party content through our Services is subject to the terms and conditions established by the respective third-party owners and may be subject to additional restrictions or requirements. Infringement Reporting: If you believe that content available through our Services infringes your intellectual property rights, please contact us using the procedures outlined in our Digital Millennium Copyright Act (DMCA) policy.
9.5 Digital Millennium Copyright Act Compliance
We comply with the Digital Millennium Copyright Act (DMCA) and have established procedures for responding to claims of copyright infringement.
DMCA Notice Procedure: If you believe that content available through our Services infringes your copyright, you may submit a DMCA takedown notice to our designated copyright agent. Your notice must include all information required by 17 U.S.C. § 512(c)(3). Counter-Notification Process: If you believe that content you submitted was removed in error, you may submit a counter-notification in accordance with DMCA procedures. Repeat Infringer Policy: We maintain a policy of terminating access to our Services for users who are repeat copyright infringers, as determined in our sole discretion.
9.6 Protection of Proprietary Information
Confidentiality Obligations: You acknowledge that our Services may contain confidential and proprietary information, including business methods, processes, and technical information. You agree to maintain the confidentiality of such information and not to disclose it to third parties. Trade Secret Protection: Certain aspects of our Services, including algorithms, processes, and methodologies, may constitute trade secrets. You agree not to reverse engineer, decompile, or otherwise attempt to discover such trade secrets. Competitive Use Restrictions: You may not use any proprietary information obtained through our Services to compete with our business or to develop competing products or services.
9.7 Enforcement of Rights
We actively protect our intellectual property rights and will take appropriate action against infringement or unauthorized use.
Legal Remedies: We reserve the right to pursue all available legal remedies, including injunctive relief and monetary damages, against individuals or entities that infringe our intellectual property rights. Cooperation with Authorities: We may cooperate with law enforcement agencies and regulatory authorities in investigating and prosecuting intellectual property violations. User Cooperation: Users agree to cooperate with our efforts to protect our intellectual property rights and to provide information and assistance as reasonably requested in connection with enforcement activities.
Evertrust Health Insurance implements comprehensive security measures to protect your Personal Information and Protected Health Information in accordance with HIPAA Security Rule requirements and industry best practices. This section outlines our security framework and your role in maintaining information security.
10.1 Technical Safeguards
We implement appropriate technical safeguards to protect electronic Protected Health Information (ePHI) and Personal Information, including encryption of data in transit and at rest, secure user authentication systems, automatic session timeouts, and regular security monitoring and auditing.
10.2 Administrative Safeguards
Our administrative safeguards include designated security officials, workforce training on privacy and security requirements, information access management procedures, and incident response protocols for addressing security breaches or suspected violations.
10.3 Physical Safeguards
We maintain appropriate physical safeguards for our facilities and equipment, including controlled access to data centers, workstation security measures, and secure disposal procedures for electronic media containing Protected Health Information.
Our Services may integrate with or rely upon third-party services and Business Associates to provide certain functionality. This section addresses our relationships with these third parties and their obligations regarding your information.
11.1 Business Associate Agreements
We enter into Business Associate Agreements (BAAs) with third-party service providers who may have access to Protected Health Information in connection with services provided to us. These agreements require Business Associates to implement appropriate safeguards and comply with HIPAA requirements.
11.2 Third-Party Integration
Our Services may include integrations with third-party systems, including healthcare provider systems, pharmacy networks, and other health-related services. Your use of such integrated services may be subject to additional terms and privacy policies.
To the maximum extent permitted by applicable law, Evertrust Health Insurance limits its liability for damages arising from or related to your use of our Services. This section establishes important limitations on our liability and your remedies.
12.1 General Limitation of Liability
EXCLUSION OF CONSEQUENTIAL DAMAGES: IN NO EVENT SHALL Evertrust Health Insurance, ITS AFFILIATES, SUBSIDIARIES, OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, OR LICENSORS BE LIABLE FOR ANY INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL, PUNITIVE, OR EXEMPLARY DAMAGES, INCLUDING BUT NOT LIMITED TO DAMAGES FOR LOSS OF PROFITS, BUSINESS INTERRUPTION, LOSS OF DATA, LOSS OF PROGRAMS, COST OF PROCUREMENT OF SUBSTITUTE SERVICES, OR OTHER INTANGIBLE LOSSES, ARISING OUT OF OR RELATED TO YOUR USE OF OUR SERVICES, REGARDLESS OF THE THEORY OF LIABILITY AND EVEN IF WE HAVE BEEN ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. LIMITATION OF DIRECT DAMAGES: OUR TOTAL LIABILITY TO YOU FOR ALL CLAIMS ARISING OUT OF OR RELATED TO YOUR USE OF OUR SERVICES, WHETHER IN CONTRACT, TORT, OR OTHERWISE, SHALL NOT EXCEED THE AMOUNT OF PREMIUMS YOU HAVE PAID TO US IN THE TWELVE (12) MONTHS PRECEDING THE EVENT GIVING RISE TO THE CLAIM, OR ONE HUNDRED DOLLARS ($100), WHICHEVER IS GREATER.
12.2 Technology-Related Limitations
System Availability: We do not guarantee that our Services will be available at all times or that they will operate without interruption, errors, or technical problems. Our Services may be temporarily unavailable due to maintenance, updates, technical difficulties, or circumstances beyond our control. Data Loss: While we implement appropriate backup and recovery procedures, we cannot guarantee against data loss due to technical failures, security breaches, or other unforeseen circumstances. You are responsible for maintaining your own records and backup copies of important information. Third-Party Technology: Our Services may rely on third-party technology, internet service providers, and other external systems. We are not liable for failures, interruptions, or problems caused by third-party technology or services. Mobile and Wireless Services: If you access our Services through mobile devices or wireless networks, we are not responsible for limitations, interruptions, or additional charges imposed by your mobile carrier or wireless service provider.
12.3 Information and Content Limitations
Information Accuracy: While we strive to provide accurate and up-to-date information through our Services, we do not warrant the accuracy, completeness, or reliability of any information, content, or materials available through our Services. Medical Information Disclaimer: As stated in our Medical Information Disclaimer, we are not liable for any decisions you make based on health information available through our Services. You should always consult with qualified healthcare professionals for medical advice and treatment decisions. Third-Party Content: We are not responsible for the accuracy, reliability, or appropriateness of content provided by third parties through our Services, including content from healthcare providers, pharmaceutical companies, or other business partners.
12.4 Security and Privacy Limitations
Security Measures: While we implement industry-standard security measures to protect your information, we cannot guarantee absolute security. We are not liable for unauthorized access to your information that occurs despite our reasonable security measures. User Security Responsibilities: You are responsible for maintaining the security of your account credentials and for any activities that occur under your account. We are not liable for damages resulting from your failure to maintain account security. Breach Notification: In the event of a security breach involving your Protected Health Information, our liability is limited to providing the notifications required by HIPAA and applicable state laws. We are not liable for consequential damages resulting from such breaches unless caused by our gross negligence or willful misconduct.
12.5 Business Operations Limitations
Insurance Coverage Decisions: Our Services are designed to provide information about your insurance coverage and benefits, but they do not replace your insurance policy documents. We are not liable for coverage decisions or benefit determinations made based on information displayed through our Services if such information differs from your actual policy terms. Provider Network Information: While we strive to maintain accurate provider network information, we are not liable for inaccuracies in provider directories or network status information. You should verify provider network participation directly with providers or by contacting our customer service department. Claims Processing: Our Services may provide information about claims status and processing, but they do not replace official claims processing procedures. We are not liable for delays or errors in claims information displayed through our Services.
12.6 Force Majeure
We are not liable for any failure or delay in performance of our Services due to circumstances beyond our reasonable control, including but not limited to acts of God, natural disasters, war, terrorism, labor disputes, government actions, internet outages, or other force majeure events.
12.7 State Law Variations
Some states do not allow the exclusion or limitation of certain types of damages, so the above limitations may not apply to you in their entirety. In such cases, our liability shall be limited to the maximum extent permitted by applicable state law.
Insurance Regulation Compliance: Nothing in this limitation of liability section is intended to limit our obligations under applicable insurance laws and regulations or to disclaim liability for acts or omissions that cannot be disclaimed under such laws. Consumer Protection Laws: These limitations are subject to applicable consumer protection laws and regulations that may provide additional rights or remedies not waived by these Terms of Service.
12.8 Exclusive Remedies
The remedies available to you under these Terms of Service are your exclusive remedies for any claims arising out of or related to your use of our Services, except as may be required by applicable law.
No Class Actions: You agree that any disputes arising under these Terms of Service will be resolved on an individual basis and that you will not participate in or seek to recover damages through class action lawsuits, collective actions, or other representative proceedings. Mitigation of Damages: You agree to take reasonable steps to mitigate any damages you may suffer as a result of problems with our Services and to provide us with reasonable opportunity to remedy any issues before seeking legal remedies.
This limitation of liability section is an essential element of the agreement between you and Evertrust Health Insurance and reflects a reasonable allocation of risk. Our Services are provided at no additional charge beyond your insurance premiums, and these limitations reflect the economic realities of providing digital services to a large number of users.
OUR SERVICES ARE PROVIDED "AS IS" AND "AS AVAILABLE" WITHOUT WARRANTIES OF ANY KIND, EITHER EXPRESS OR IMPLIED. TO THE MAXIMUM EXTENT PERMITTED BY APPLICABLE LAW, WE DISCLAIM ALL WARRANTIES, INCLUDING BUT NOT LIMITED TO IMPLIED WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, AND NON-INFRINGEMENT.
We do not warrant that our Services will be uninterrupted, error-free, or completely secure. We do not warrant the accuracy, completeness, or reliability of any information available through our Services.
We reserve the right to modify these Terms of Service at any time by posting updated terms on our website. We will provide notice of material changes through our Services or by other appropriate means. Your continued use of our Services after such modifications constitutes acceptance of the updated terms.
We may suspend or terminate your access to our Services at any time for violation of these Terms of Service, fraudulent activity, or other reasons as determined in our sole discretion. You may terminate your use of our Services at any time by discontinuing access to our digital platforms.
These Terms of Service and your use of our Services are governed by and construed in accordance with the laws of the State of South Carolina, without regard to its conflict of law principles. This section establishes the legal framework for resolving disputes and interpreting these Terms.
17.1 Applicable Law
State Law Governance: These Terms of Service shall be governed by and construed in accordance with the laws of the State of South Carolina, where Evertrust Health Insurance is incorporated and maintains its principal place of business. Federal Law Application: Where applicable, federal laws and regulations, including HIPAA, federal insurance regulations, and other federal statutes, shall also apply to your use of our Services and our obligations as a health insurance company. Regulatory Compliance: Nothing in these Terms of Service shall be construed to limit or waive our obligations under applicable state insurance laws, federal healthcare regulations, or other regulatory requirements governing our business operations.
17.2 Jurisdiction and Venue
Exclusive Jurisdiction: Any legal action or proceeding arising out of or relating to these Terms of Service or your use of our Services shall be brought exclusively in the state or federal courts located in North Myrtle Beach, South Carolina. You consent to the personal jurisdiction of such courts and waive any objection to venue in such courts. Waiver of Jurisdictional Defenses: By using our Services, you waive any and all jurisdictional and venue defenses that might otherwise be available to you and agree to submit to the jurisdiction of the courts specified above. Service of Process: You agree to accept service of process by mail and hereby appoint the Secretary of State of South Carolina as your agent for service of process if you cannot be personally served.
17.3 Dispute Resolution
Informal Resolution: Before initiating any formal legal proceedings, you agree to attempt to resolve disputes through informal negotiations by contacting our customer service department. We are committed to working with you to resolve issues promptly and fairly. Limitation Period: Any claim or cause of action arising out of or related to your use of our Services must be filed within one (1) year after the claim or cause of action arose, or it will be forever barred, except where prohibited by applicable law. Individual Disputes Only: You agree that any disputes will be resolved on an individual basis and that you will not seek to resolve disputes through class action lawsuits, collective actions, or other representative proceedings.
If you have questions about these Terms of Service, need assistance with our Services, or wish to report issues or concerns, you may contact us through the following methods:
18.1 Customer Service
Phone: (704)-617-5151 Hours: Monday through Friday, 8:00 AM to 6:00 PM Eastern Time TTY/TDD: (704)-617-5151 for hearing impaired
18.2 Written Correspondence
Mailing Address: Evertrust Health Insurance 4316 Windy Heights Drive North Myrtle Beach, SC 29582 Email: [email protected]
18.3 Privacy and HIPAA Inquiries
Privacy Officer: [email protected] HIPAA Compliance: [email protected] Privacy Complaints: [email protected]
18.4 Legal and Regulatory Matters
Legal Department: [email protected] Regulatory Compliance: [email protected] DMCA Agent: [email protected]
18.5 Technical Support
Technical Support: [email protected] Website Issues: [email protected] Mobile App Support: [email protected]
When contacting us, please provide your name, member ID (if applicable), and a detailed description of your question or concern. For privacy and security reasons, we may need to verify your identity before discussing specific account information or Protected Health Information.
If any provision of these Terms of Service is found to be invalid, illegal, or unenforceable by a court of competent jurisdiction, the remaining provisions shall continue in full force and effect. The invalid provision shall be modified to the minimum extent necessary to make it valid and enforceable while preserving the original intent of the provision.
These Terms of Service, together with our Privacy Notice and any other policies or agreements specifically incorporated by reference, constitute the entire agreement between you and Evertrust Health Insurance regarding your use of our Services. These Terms supersede all prior or contemporaneous communications, proposals, and agreements relating to the subject matter herein.
No modification of these Terms of Service shall be effective unless made in writing and signed by an authorized representative of Evertrust Health Insurance. No waiver of any provision of these Terms shall be deemed a waiver of any other provision or of the same provision on a future occasion.
Effective Date: 08/24/2025 Last Updated: 08/24/2025 Version: 1.0
© 2025 Evertrust Health Insurance. All rights reserved.
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This document was prepared by Manus AI and should be reviewed by qualified legal counsel before implementation.