HIPAA-compliant platform · encrypted storage · nightly carrier reporting—
| Component | Basis | Amount |
|---|---|---|
| Infrastructure & Service Fee | — | — |
| Per dvID audit fee | — | — |
| dvID hold fee | — | — |
| ↳ Audit period | — | — |
| ↳ Grace period | — | — |
| Cost base | — | |
| Gross margin markup | — | — |
| Sales commission | — | — |
| Infrastructure & Service Fee | — |
The Grace Period allows employees who submitted late documentation additional time to complete verification. dvIDs remain active and billable at the hold fee rate for the full duration including grace period.
| Metric | Value | Basis |
|---|---|---|
| Total dependent population (est.) | — | BE lives × avg. deps per employee |
| Est. ineligible dependents | — | Total deps × ineligible rate % |
| ↳ Ineligible children (est.) | — | — |
| ↳ Ineligible spouse/partner (est.) | — | — |
| Avg. monthly cost per ineligible dependent | — | Weighted avg. across dep types |
| Monthly savings — all ineligible removed | — | Ineligible count × avg. monthly cost |
| Annual savings — all ineligible removed | — | Monthly savings × 12 |
| Records needed to cover audit cost | — | Audit total ÷ avg. monthly dep cost |
| Payback period (months) | — | Audit total ÷ monthly savings |
| 12-month net savings | — | Annual savings − audit cost |
| 24-month net savings | — | (Annual savings × 2) − audit cost |
| 3-year net savings | — | (Annual savings × 3) − audit cost |
| Event | Population | dvID | Count | Multiplier | Rate basis | Amount |
|---|---|---|---|---|---|---|
| New hire (NH) | NE or NBE→BE / new | Issued | — | × 0.75 | — | — |
| Job status change — NE/NBE → BE | NE or NBE→BE | Issued | — | × 0.75 | — | — |
| QLE — life event | BE — document processing | Billable | — | × 0.75 | — | — |
| AOD — aging out | BE — notifications & services | Billable | — | × 0.50 | — | — |
| Additions subtotal | — | |||||
| Job status change — BE → NE or NBE | BE→NE / NBE | Deactivated | — | $0.00 | Admin — dvID deactivated, moved to NE or NBE | $0.00 |
| Termination (TRM) | BE→removed | Deactivated | — | $0.00 | Admin — removed from census & NBE | $0.00 |
| Retirement (RET) | BE→removed | Deactivated | — | $0.00 | Admin — removed from census & NBE | $0.00 |
| Removals subtotal | $0.00 | |||||
| Net BE adjustment | — |
Birth · Adoption · Legal Guardianship · Marriage · Domestic Partnership Declaration · Losing Other Coverage · Death of Dependent · End of Legal Guardianship · Divorce · Domestic Partnership Termination · Gaining Other Coverage
All qualifying life events trigger document processing regardless of coverage direction. Billed at 0.75×. The dV ID is unaffected — it remains active as long as the member is Benefits Eligible.
AOD — aging out (× 0.50)
Grandchild aging out (18-month limit) · Dependent aging out (age 26)
Service delivery event — notifications and coverage transition guidance delivered to member and dependent. dV ID remains active after the aged-out dependent is dropped from coverage. Billed at 0.50×.
JSC: NBE → BE (× 0.75) — dvID issued. First billable event for that employee.
JSC: BE → NBE ($0.00) — Administrative status change. dvID deactivated, member moved to NBE population. No billing.
Termination (TRM) ($0.00) — Administrative removal. dvID deactivated, member removed from census and NBE population entirely. No billing.
Retirement (RET) ($0.00) — Administrative removal. dvID deactivated, member removed from census and NBE population entirely. No billing.
| Component | Category | Monthly | Annual | % of fee |
|---|
| Line item | Type | Monthly (cost) | Client price |
|---|
| Component | Description | Monthly fee |
|---|
1.1 "Benefits Eligible (BE)" means any employee who qualifies for benefits coverage under the Client's plan and to whom a docVERIFY ID (dV ID) has been issued.
1.2 "Not Enrolled (NE)" means any employee who is Benefits Eligible but has not yet enrolled in coverage. NE employees are carried on record and are not assigned a dvID until they enroll. No fees apply to the NE population.
1.2a "Not Benefits Eligible (NBE)" means any employee who does not qualify for benefits coverage. NBE employees are carried in the census file for workforce tracking purposes. No dV ID is issued and no fees apply to NBE employees.
1.3 "dvID" means a unique docVERIFY identifier issued to a Benefits Eligible employee at the first qualifying eligibility event. The dV ID is the unit of billing for recurring monthly services.
1.4 "Census File" means the monthly data submission provided by Client containing all employees in three categories: Benefits Eligible (BE), Not Enrolled (NE), and Not Benefits Eligible (NBE). The sum of BE + NE + NBE equals the total employee population. Only the BE population is assigned dvIDs and subject to monthly fees.
1.5 "Census Change Event" means any addition to or removal from the Benefits Eligible population or dependent coverage during a billing period, including:
- New Hire (NH) — new employee entering BE status
- JSC: NBE → BE — Job Status Change resulting in eligibility; dvID issued
- JSC: BE → NBE — Job Status Change resulting in loss of eligibility; dvID deactivated; employee remains on record as NBE
- QLE+ (coverage added) — Birth, Adoption, Legal Guardianship, Marriage, Domestic Partnership Declaration, Losing Other Coverage
- QLE− (coverage removed) — Death of Dependent, End of Legal Guardianship, Divorce, Domestic Partnership Termination, Gaining Other Coverage
- Auto-term — Grandchild aging out (18-month coverage limit), Dependent aging out (age 26); system-triggered, no census file submission required
- Termination — involuntary or unplanned separation from employment
- Retirement — planned separation from employment
docVERIFY agrees to provide the following services during the term of this Agreement:
- Dependent eligibility document collection via secure tokenized upload portal
- Document review and eligibility determination via daily batch processing (batched 2:00 AM EST, dispatched 7:00 AM EST), with turnaround commitments per Section 5.1
- Benefits Eligible census management, including monthly change processing within 5 business days of Census File receipt
- Administrative dashboard access for Client HR and benefits administrators
- Platform infrastructure — Supabase, Render, Netlify, SendGrid, encrypted document storage (AWS S3), monitoring and security services
- Audit trail maintenance and compliance recordkeeping
- Annual and event-based recertification management
3.1 Flat Audit Fee. Client shall pay a fixed monthly flat audit fee of —, comprising:
- Administrative Dashboard: Administration/QC and cloud storage — —/month
- Technology Systems: Quickbase, Parsio, Adobe Suite, and Microsoft Office — —/month
The Flat Audit Fee is fixed and does not vary with census size or activity volume.
3.2 Per dvID Fee. Client shall pay a monthly fee of — per active dV ID (Benefits Eligible life) as of the first business day of each billing period. The base monthly dvID fee for — active dvIDs is —.
3.3 Census Change Adjustments. Monthly billing adjustments for Census Change Events are calculated based on the Per dvID Fee as follows:
- NH charge: 0.75× the Per dvID Fee
- JSC: NBE → BE (dvID issued): 0.75× the Per dvID Fee
- QLE — life event: 0.75× the Per dvID Fee — document processing for any qualifying life event regardless of coverage direction; dV ID unaffected
- AOD — aging out: 0.50× the Per dvID Fee — notifications and coverage transition services; dV ID remains active after dependent removed from coverage
- JSC: BE → NBE (dvID deactivated): $0.00 — administrative status change; member moved to NBE population
- Termination (TRM): $0.00 — administrative removal; dvID deactivated, member removed from census and NBE population entirely
- Retirement (RET): $0.00 — administrative removal; dvID deactivated, member removed from census and NBE population entirely
Credits and charges are net-settled on the same monthly invoice. No separate credit memo is issued.
3.4 NBE Population. Employees classified as Non-Benefit Eligible (NBE) in the Census File are carried on record at no charge. No dV ID is issued and no fee applies until an NBE employee experiences a qualifying eligibility event.
4.1 Invoices are issued on the first business day of each calendar month. Payment is due within 30 days of invoice date.
4.2 Census Files must be submitted by the last business day of each month. Changes submitted after this date will be processed in the following billing cycle.
4.3 Annual prepayment of — entitles Client to a 10% discount on the monthly rate for a 12-month period.
4.4 Late payments accrue interest at 1.5% per month on the outstanding balance.
5.1 Document turnaround. docVERIFY processes submitted documents in daily batches. All documents received via the secure upload portal on or before 2:00 AM EST are included in that day's batch, assigned for processing at 7:00 AM EST daily, excluding federal holidays. Documents received after 2:00 AM EST will be held and included in the following day's batch run. Turnaround times commence upon batch dispatch. docVERIFY guarantees document review decisions within 48 hours (standard) or 24 hours (priority) from the time the batch is assigned and dispatched.
5.2 Federal holiday exclusion. Batch processing does not occur on the following federally observed holidays. Documents received on or before 2:00 AM EST of a holiday are held and included in the next scheduled batch on the following non-holiday business day. SLA clocks are suspended for the duration of any federal holiday and resume upon batch dispatch on the next processing day: New Year's Day (Jan 1) · Martin Luther King Jr. Day (3rd Mon. Jan) · Presidents' Day (3rd Mon. Feb) · Memorial Day (Last Mon. May) · Juneteenth (Jun 19) · Independence Day (Jul 4) · Labor Day (1st Mon. Sep) · Columbus Day (2nd Mon. Oct) · Veterans Day (Nov 11) · Thanksgiving Day (4th Thu. Nov) · Christmas Day (Dec 25). When a holiday falls on Saturday, the preceding Friday is observed; on Sunday, the following Monday is observed. An annual processing calendar will be provided to Client at the start of each calendar year.
5.3 Accuracy. docVERIFY guarantees a monthly review accuracy rate of 98% or greater. A 10% random sample of completed reviews is re-reviewed monthly for QA purposes.
5.4 Census processing. Monthly Census File changes will be processed within 5 business days of receipt of the completed Census File.
5.5 System availability. The docVERIFY platform will be available 99% of the time monthly, excluding scheduled maintenance windows communicated at least 48 hours in advance.
5.6 SLA breach credit. For each month in which docVERIFY fails to meet any SLA commitment in Sections 5.1–5.5, Client shall receive a credit equal to 5% of that month's invoice, applied to the following month's billing. Credits are the sole remedy for SLA breaches and are non-cumulative (maximum: 5% per month).
5.7 Escalation. Documents unresolved beyond the applicable turnaround commitment are automatically escalated to a senior reviewer. Client will be notified within 4 business hours of escalation.
6.1 All dependent documentation is transmitted via secure, tokenized, time-limited upload links (HTTPS). Documents are encrypted in transit and at rest.
6.2 docVERIFY maintains a complete and tamper-proof audit log of all verification activities, accessible to authorized Client administrators.
6.3 Both parties agree to maintain the confidentiality of all non-public information exchanged under this Agreement.
7.1 This Agreement commences on Start date and continues for an initial term of 12 / 24 months. Following the initial term, this Agreement automatically renews on an annual basis unless terminated by either party as set forth herein.
7.2 Either party may terminate this Agreement with 60 days written notice. Annual prepay agreements terminated early are subject to a pro-rated refund of unused months less a 10% early termination fee.
7.3 Upon termination, Client data and uploaded documents will be retained for 90 days and then securely destroyed unless Client requests earlier deletion.
This Agreement constitutes the entire agreement between the parties with respect to its subject matter. Neither party may assign this Agreement without the prior written consent of the other. This Agreement shall be governed by the laws of the state of State. Any dispute shall be resolved by binding arbitration.
BE = Benefits Eligible — actively enrolled in coverage (all enrolled tiers)
NE = Not Enrolled (EE Waived) — Benefits Eligible but opted out of coverage · dvID Issued · hold rate
NBE = Not Benefits Eligible — does not qualify for benefits · no dvID · $0.00
TRM = Terminations — removed from census — $0.00
RET = Retired — removed from census — $0.00
dvID Billable = EE+SP + EE+CH + EE+DP + EE+DPC + EE+FAM // enrolled with dependents — full rate
dvID Issued = NE (EE Waived) + EE Only // waived or enrolled without dependents — hold rate · must submit proof of credible coverage if waived
dvID Inactive = NBE + TRM + RET // not eligible or off census — $0.00
MED Opt-Out count floor = NE (EE Waived) count // locked to Waived count — can be adjusted upward for additional opt-outs
documentation required: proof of credible coverage dated within 30 days of group plan effective date
MED Opt-Out fee = Waived count × $0.75/dvID // add-on billed monthly
Phase 1 — Pilot: ~$40/mo // development/testing only · no BAA
Phase 2 — HIPAA Live: ~$800/mo (default) // first real client · Supabase Team + AWS BAA
Phase 3 — Full Platform: ~$1,500/mo // scale · Supabase Enterprise
negotiation range: $750 floor (pilot/negotiated) → $1,500 ceiling (Phase 3 full platform)
// fixed monthly — does not scale with census size or document volume
suggested rate = $5.00 (<100 BE) · $4.00 (100–499) · $3.00 (500–1,999) · $2.00 (2,000–4,999) · $1.00 (5,000+)
// larger census → lower per-dvID rate · adjust freely with slider
JSC charge (NE→BE) = count × dvID rate × 0.75 // waived employee re-enrolls in coverage — dvID moves from Issued to Billable
JSC charge (NBE→BE) = count × dvID rate × 0.75 // NBE employee becomes eligible and enrolls — dvID issued · first billable event
JSC (BE→NE) = $0.00 // enrolled employee waives coverage · dvID moves from Billable to Issued · hold rate applies · MED Opt-Out triggered
JSC (BE→NBE) = $0.00 // administrative status change — dvID deactivated, member moved to NBE
QLE charge = count × dvID rate × 0.75 // all life events — document processing regardless of coverage direction
AOD charge = count × dvID rate × 0.50 // aging out — notifications & services; dvID remains active
termination (TRM) = $0.00 // administrative removal — dvID deactivated, member removed from census & NBE
retirement (RET) = $0.00 // administrative removal — dvID deactivated, member removed from census & NBE
// floor auto-set from census · slide right to model higher exposure
Total dependents = (EE+SP × 1) + (EE+CH × 1) + (EE+FAM × 2) + (EE+DP × 1) + (EE+DPC × 1)
Avg deps per EE = Total dependents ÷ (BE + NBE)
// EE+FAM assumes 1 spouse + 1 child · floor auto-set from tiers · slide right to model higher
Est. ineligible count = Total dependents × Est. ineligible rate
Est. annual exposure = (Ineligible count × Avg monthly premium × 12) + (Ineligible count × Avg annual claims cost)
// The Advanced Monthly Premium: cost incurred regardless of whether the dependent makes any claims
Claims Cost = ineligible dependent count × avg annual claims cost per dependent
// The Potential Claims Cost: medical, pharmacy, or ancillary utilization up to plan limits
Total Annual Exposure = Premium Cost + Claims Cost
Audit Duration = core document collection and review window (months)
Grace Period = extended window for late submissions — dvIDs remain billable at hold rate
dV ID hold fee total = BE count × hold rate × (audit duration + grace period)
pre-commission price = cost base ÷ (1 − margin %)
commission = dvID base fee × commission % // applied on dvID fee only — not on audit fee or add-ons
client invoice = pre-commission price + commission
annual prepay = client invoice × 12 × 0.90
published rate /dvID = (Infrastructure & Service Fee + base dvID fee + margin markup + commission) ÷ active BE lives
// excludes variable census change charges and add-ons
// this is the rate shown on contracts, proposals, and client-facing documents
defaults: Infrastructure & Service Fee $1,125 (HIPAA Live) · Commission 15% · Target gross margin 40% · Grace period 3 months