Terms and Conditions

• You are at least 18 years old or have obtained parental/guardian consent.
• You are an eligible student enrolled at a U.S. university.
• You have provided accurate and truthful information during the application process.

• Provide accurate personal and academic information.
• Maintain active student status to remain eligible for coverage.
• Inform Gradly immediately if your university rejects your waiver request.
• Abide by the terms of the provider and third-party partners (such as Cigna PPO, First Health, OptumRX, and USRx).
• Not misuse, manipulate, or attempt fraudulent activities related to your plan coverage.

• Coverage is subject to the specific terms outlined in your plan documents.
• The plan period starts on the coverage start date and ends on the coverage end date.
• Claims must be submitted in accordance with the insurer's guidelines & reimbursement request must be submitted within 180 days from the date of service.
• Gradly does not process claims directly—claims are managed by third-party administrators.
• Gradly may, update, modify, or transition the plan administrators, third-party administrators (TPAs), service providers, provider networks, or affiliated partners involved in the delivery, administration, or servicing of health coverage offered through the platform.
• Such changes may be made to improve service quality, expand provider access, enhance operational efficiency, or comply with regulatory or business requirements. These updates will not reduce the core scope of coverage provided under an active plan, though certain administrative processes, provider networks, claims handling procedures, or supporting partners may change.
• By accessing or continuing to use the Gradly web application, mobile application, or related services, you acknowledge and consent to Gradly facilitating health coverage through its current or future affiliated partners, administrators, and networks, as applicable.
• These updates may include access to enhanced or expanded provider networks and improvements to how plan services are accessed and managed through Gradly’s updated platform experience. Such changes are intended to improve overall usability, network availability, and service delivery; however, specific providers, network composition, and administrative processes may vary over time and by location.
• Coverage terms, benefits, exclusions, and limitations are governed by the applicable plan documents issued by the respective provider or administrator in effect at the time of coverage.
• Continued use of the platform following any such updates constitutes acceptance of these changes.

When service provider changes occur, Gradly will:

• Notify affected members via email and/or in-app notification.
• Update the Platform to reflect the current service provider designations.

Current Service Providers (as of the most recent update to these Terms):

• Provider Network: First Health Network
• Pharmacy Benefit Manager: OptumRx
• Virtual Care Provider: Teladoc Health
• Third-Party Plan Administrator: Five Points Student Health

If you elect to opt out:

• Your request will be processed in accordance with the governing plan documentation.
• Opting out may result in modification or termination of certain benefits, including access to the designated provider network, pharmacy benefit services, virtual care platform, and related member support functions.
• All opt-out elections are final upon processing and subject to applicable regulatory requirements.

• All plan premiums must be paid in full after the waiver is accepted.
• Payment processing is handled by Stripe & Mercury and is subjected to their terms.
• Chargebacks or unauthorized disputes may result in plan cancellation and additional fees.
• Any fees related to transactions, including processing fees, are non-refundable.
• Late Fees: If the outstanding premium is not settled within 7 days after waiver approval, a late fee of $50 per week will be incurred.

• The collection of personal, academic, and plan-related data.
• The secure sharing of data with third parties (Cigna PPO, First Health, OptumRX, USRx, and others) for plan processing.
• SMS communications in compliance with A2P 10DLC regulations (opt-out available by replying 'STOP').
• Secure data transfers via EDI 834 for enrollment and claims processing.

• Handling of Protected Health Information (PHI): Certain plan-related data may qualify as PHI under HIPAA regulations. We implement safeguards to protect PHI in compliance with HIPAA and other privacy laws.
• EDI 834 Data Transfers: We securely exchange plan enrollment data with third parties using EDI 834 standards.
• Third-Party Compliance: Partners handling PHI on our behalf are required to follow HIPAA security standards.

• Decisions made by universities, plan underwriters, or claims administrators.
• Losses resulting from failure to comply with waiver deadlines.
• Delays or service interruptions caused by third parties.
• Healthcare expenses beyond plan coverage.

• Any disputes arising under these Terms & Conditions shall be resolved through binding arbitration, in accordance with AAA (American Arbitration Association) rules.
• Users waive the right to a class-action lawsuit.
• Claims must be filed within one year of the issue arising.