1. Acceptance of Terms
These Terms & Conditions (“Terms”) govern your access to and use of the website located at optimyl.com and any associated subdomains, portals, and digital resources (collectively, the “Website”) operated by Optimyl Benefits (“Optimyl,” “we,” “us,” or “our”), a Managing General Underwriter (“MGU”) providing level-funded health, dental, and vision plans to small employers.
By accessing or using the Website, you confirm that you have read, understood, and agree to be bound by these Terms and our Privacy Policy, which is incorporated herein by reference. If you do not agree, you must not access or use the Website.
These Terms apply to all visitors, employers, plan members, licensed brokers, and any other individuals who access the Website (collectively, “Users” or “you”).
2. About Optimyl Benefits
Optimyl Benefits is an MGU that designs, underwrites, and administers level-funded medical, dental, and vision benefit plans for small employers across the United States. Our self-funded program enables employers to establish and provide group health coverage to their employees. Stop Loss Insurance is underwritten by The North River Insurance Company or Gerber Life Insurance Company. Stop Loss coverage may vary or may not be available in all states.
The Website serves as an informational resource and access point for our employer portal, member portal, and broker portal. Nothing on the Website constitutes a binding insurance contract or coverage offer. Actual coverage is governed solely by the applicable plan documents, Summary Plan Description (“SPD”), and any applicable Group Insurance Certificate.
3. Eligibility and Account Access
Use of certain features of the Website, including the employer, member, and broker portals, requires account credentials. By registering for or using a portal account, you represent and warrant that:
You must notify us immediately at contactus@optimyl.com if you suspect unauthorized access to your account. We reserve the right to suspend or terminate access to any account at our sole discretion, including for suspected fraud or breach of these Terms.
4. License to Use the Website
Subject to these Terms, Optimyl grants you a limited, non-exclusive, non-transferable, revocable license to access and use the Website for your personal or internal business purposes. This license does not include the right to:
Any rights not expressly granted herein are reserved by Optimyl.
5. Acceptable Use
You agree to use the Website only for lawful purposes and in compliance with all applicable federal and state laws and regulations, including HIPAA, state insurance regulations, and applicable data protection laws. You must not:
Violation of this section may result in immediate termination of your access and may be referred to appropriate law enforcement authorities.
6. Intellectual Property
Unless otherwise stated, all content on the Website — including text, graphics, logos, icons, images, plan documents, portal interfaces, and software — is the exclusive property of Optimyl Benefits or its content suppliers and is protected by applicable U.S. and international copyright, trademark, and other intellectual property laws.
The Optimyl Benefits name, logo, and tagline are trademarks of Optimyl Benefits. You may not use any Optimyl trademark or trade dress without our prior written consent.
You are permitted to download and print individual pages from the Website for your personal, non-commercial reference only, provided you do not remove any copyright or proprietary notices.
7. Third-Party Links and Services
The Website may contain links to third-party websites, platforms, or services, including but not limited to Allied Benefit Systems (our TPA portal), VSP (vision plan), and stop-loss carrier portals. These links are provided for convenience only. Optimyl does not endorse, control, or take responsibility for the content, privacy practices, or terms of any third-party sites.
Your use of any third-party site is governed by that site’s own terms and conditions and privacy policy. We encourage you to review those documents before interacting with third-party services.
8. Health Information and Insurance Disclaimer
Content on the Website relating to health plans, benefit levels, network providers, pharmacy benefits, and plan costs is provided for general informational purposes only and does not constitute medical advice, legal advice, or a binding insurance quote or offer.
Plan availability, benefit levels, rates, and stop-loss coverage vary by state and group eligibility. Actual plan terms are governed solely by the applicable plan documents. Optimyl makes no representation that any specific plan or benefit described on the Website is available in your state or for your group.
Important: Coverage decisions, eligibility determinations, and claims are governed by your plan documents and Summary Plan Description (SPD), not by information on this Website.
9. Disclaimer of Warranties
The website and all content, materials, and services available through it are provided on an “as is” and “as available” basis, without warranty of any kind, either express or implied.
To the fullest extent permitted by applicable law, Optimyl expressly disclaims all warranties, including but not limited to:
Some jurisdictions do not allow the exclusion of implied warranties. In such jurisdictions, the above exclusions apply only to the fullest extent permitted by law.
10. Limitation of Liability
To the fullest extent permitted by applicable law, in no event shall Optimyl Benefits, its officers, directors, employees, affiliates, agents, licensors, or service providers be liable for any indirect, incidental, special, consequential, punitive, or exemplary damages, including but not limited to loss of revenue, loss of data, loss of goodwill, or cost of substitute services, arising out of or related to your use of or inability to use the website, even if advised of the possibility of such damages.
In no event shall Optimyl’s total aggregate liability to you for any claims arising out of or related to these Terms or your use of the Website exceed the greater of (a) one hundred dollars ($100.00) or (b) the total amounts paid by you to Optimyl in the six (6) months immediately preceding the event giving rise to the claim.
The limitations in this section apply regardless of the legal theory on which a claim is based, including contract, tort, strict liability, or otherwise.
11. Indemnification
You agree to defend, indemnify, and hold harmless Optimyl Benefits and its officers, directors, employees, agents, licensors, and service providers from and against any claims, liabilities, damages, judgments, awards, losses, costs, and expenses (including reasonable attorneys’ fees) arising out of or related to:
12. Privacy
Your use of the Website is also governed by our Privacy Policy, available at www.optimyl.com/privacy-policy, which is incorporated into these Terms by this reference. By using the Website, you consent to our collection and use of your information as described in the Privacy Policy.
To the extent we act as a health plan or business associate under HIPAA, our handling of Protected Health Information (PHI) is additionally governed by our HIPAA Notice of Privacy Practices, provided separately to plan members.
13. Changes to the Website and These Terms
We may update these Terms or modify, suspend, or discontinue the Service at any time without notice. Changes take effect upon posting. Continued use constitutes acceptance of updated Terms.
14. Governing Law and Dispute Resolution
These Terms are governed by and construed in accordance with the laws of the State of Wisconsin, without regard to its conflict of law principles, reflecting Optimyl’s administrative operations.
Any dispute arising out of or relating to these Terms or your use of the Website that cannot be resolved informally shall be subject to the exclusive jurisdiction of the state and federal courts located in Milwaukee, Wisconsin. You and Optimyl each waive any objection to such jurisdiction and venue.
Nothing in these Terms limits either party’s right to seek injunctive or other equitable relief in any court of competent jurisdiction for matters involving intellectual property, confidentiality, or unauthorized use of the Website.
15. Regulatory Compliance
Optimyl Benefits operates as a licensed entity subject to state insurance regulations in the states where it does business. These Terms do not supersede or modify any obligations imposed by applicable state or federal insurance law, including the Affordable Care Act (ACA), HIPAA, ERISA, or applicable state insurance regulations.
Nothing in these Terms shall be interpreted to limit any rights you may have under applicable law as a plan participant, beneficiary, employer plan sponsor, or licensed broker.
16. General Provisions
16.1 Entire Agreement
These Terms, together with our Privacy Policy and any applicable plan documents, constitute the entire agreement between you and Optimyl with respect to your use of the Website and supersede all prior or contemporaneous understandings.
16.2 Severability
If any provision of these Terms is found to be invalid, unlawful, or unenforceable, that provision will be modified to the minimum extent necessary to make it enforceable, and the remaining provisions will continue in full force and effect.
16.3 Waiver
No waiver by Optimyl of any term or condition set forth in these Terms shall be deemed a further or continuing waiver of such term or any other term, and any failure by Optimyl to assert a right or provision under these Terms shall not constitute a waiver of such right or provision.
16.4 No Agency
Nothing in these Terms creates any agency, partnership, joint venture, employment, or franchise relationship between you and Optimyl.
16.5 Assignment
You may not assign or transfer your rights or obligations under these Terms without our prior written consent. Optimyl may freely assign these Terms, including in connection with a merger, acquisition, or sale of assets.
16.6 Force Majeure
Optimyl shall not be liable for any failure or delay in performance caused by circumstances beyond our reasonable control, including acts of God, natural disasters, government actions, labor disputes, cyberattacks, or failures of third-party service providers.
17. Contact Us
If you have questions or concerns about these Terms, please contact us at:
Optimyl Benefits
Phone: 800-621-0748
Email: contactus@optimyl.com
Website: optimyl.com