Terms of Service

These Terms of Service ("Terms") govern access to and use of websites, applications, APIs, portals, care-navigation tools, provider tools, employer tools, and related services offered by Prescience, Inc. d/b/a Prescience Administrative Services ("Prescience," "we," "us," or "our").

By accessing or using the services, you agree to these Terms. If you use the services on behalf of an employer, health plan, provider organization, broker, consultant, or other entity, you represent that you are authorized to bind that entity and its authorized users.

A signed order form, master services agreement, business associate agreement, provider agreement, data processing agreement, plan document, or other written agreement with Prescience may include additional terms. If those written terms conflict with these Terms, the written agreement controls for the conflicting subject matter.

Prescience provides technology and administrative services for employer-sponsored health benefits, including benefits operations, plan analytics, care navigation, provider discovery and scheduling support, claims and payment workflows, funding operations, and related tools through partner institutions.

Prescience is not an insurance carrier, bank, broker-dealer, investment adviser, or licensed medical provider unless expressly stated in a separate written agreement. Banking, card, payment, record-retrieval, telehealth, provider, and insurance-related services may be provided by third-party partners subject to their own terms.

We may modify, suspend, or discontinue any feature at any time. Features described on our website may require a separate agreement, eligibility, implementation work, or regulatory review before use.

• Employers and plan sponsors use Prescience to evaluate, sponsor, administer, fund, and monitor health-benefit programs for eligible employees and dependents.
• Members and patients use Prescience to understand benefits, navigate care, connect records, manage permissions, request support, and access services available through their plan.
• Providers and provider organizations use Prescience to participate in network, direct-contract, scheduling, payment, claim, or administrative workflows.
• Brokers, consultants, TPAs, administrators, and partners may use Prescience to support plan selection, implementation, administration, integrations, or customer support.

You are responsible for maintaining the confidentiality of your credentials and for activity under your account. You must provide accurate, current information and promptly update information that changes, including eligibility, enrollment, contact, payment, licensing, credentialing, banking, tax, and provider information when applicable.

You may access only the portals, records, data, and workflows you are authorized to access. You may not share credentials, impersonate another person, bypass role-based restrictions, or use another account without authorization.

Employers and plan sponsors are responsible for their own plan design decisions, fiduciary duties, workforce communications, eligibility files, payroll and census accuracy, plan documents, required notices, tax treatment, ERISA, ACA, COBRA, HIPAA, state-law, and other compliance obligations unless a written agreement states otherwise.

Employer-facing dashboards are designed to show aggregate, de-identified, financial, operational, eligibility, and plan-administration information. Employers may not attempt to identify a member from aggregate reporting or use Prescience to make employment decisions based on individual health information.

If you provide employee, dependent, payroll, claims, eligibility, or other data to Prescience, you represent that you have all rights, consents, notices, authorizations, plan-document permissions, and legal bases needed to provide that data and allow Prescience to process it for the services.

Prescience has permission to refresh your claims, EOBs, and member IDs weekly, and may request MFA from the patient.

Member tools are intended to help you understand your benefits, compare care options, request care navigation, connect records, and coordinate payments where available. You are responsible for the information you provide and for reviewing plan materials, provider instructions, appointment details, and payment information.

Prescience care-navigation tools, including Crystal, do not diagnose, prescribe, or replace clinicians. They are not for emergencies. If you believe you may have a medical emergency, call 911 or seek emergency care immediately. Do not delay care because of information provided by Prescience.

Some member features require signed permissions, such as HIPAA authorization, records-release authorization, telehealth consent, or financial responsibility acknowledgment. If you act for a dependent or another person, you represent that you have legal authority to do so.

Providers and provider organizations remain solely responsible for clinical judgment, professional licensure, credentialing, documentation, coding, medical necessity, patient consent, billing accuracy, claim submissions, tax information, and compliance with applicable professional, healthcare, privacy, fraud-and-abuse, and payment laws.

If you participate in a Prescience network, direct-contract, scheduling, claims, payment, or provider-profile workflow, you agree to provide accurate practice, NPI, TIN, licensure, availability, pricing, balance-billing, and payment information and to honor the applicable written agreement, posted participation rules, and patient commitments.

Prescience does not control the practice of medicine and does not guarantee patient volume, reimbursement, authorization, claim approval, or payment outside the applicable written terms.

You agree not to:

• Use the services for any unlawful, discriminatory, or abusive purpose;
• Attempt to access systems, data, PHI, or accounts without authorization;
• Interfere with the integrity, security, or performance of the services;
• Upload malicious code, misleading information, or data you are not authorized to provide;
• Reverse engineer, scrape, benchmark, or copy the services except as permitted by law or a written agreement;
• Use outputs to make employment, underwriting, clinical, or legal decisions without appropriate human review and legal authority;
• Use PHI or personal information for marketing, employment, or non-plan purposes unless expressly permitted by law and written agreements; or
• Use the services in a way that violates HIPAA, ERISA, ACA, anti-kickback, false-claims, privacy, consumer-protection, or other applicable laws.

Our Privacy Policy describes how we collect, use, disclose, and protect information. To the extent information is protected health information (PHI), we process it only as permitted by HIPAA, the applicable Business Associate Agreement (BAA), other written agreements, and applicable law.

Prescience does not sell PHI. We do not use PHI for marketing. We may create and use aggregated or de-identified information as permitted by HIPAA, the applicable BAA, and applicable law.

You retain ownership of data you provide. You grant Prescience a limited license to host, process, transmit, display, analyze, and otherwise use that data as necessary to provide, secure, support, and improve the services and as otherwise permitted by written agreements and law.

If you enable Gmail-based insurance paperwork tracking, you authorize Prescience to use read-only Gmail access for the limited purposes described in our Privacy Policy. You may disconnect the mailbox at any time. Disconnecting stops future monitoring but does not automatically remove insurance case or health-plan records that Prescience must retain under applicable law, healthcare obligations, or written agreements.

Prescience may send a one-time verification code when you request one during sign-in to a live account. If you separately opt in during member onboarding or through your permissions, Prescience may also send recurring transactional care coordination, appointment, benefits, billing, account, and support notifications. Optional notification consent is not a condition of care, plan benefits, or purchase.

Message frequency varies. Message and data rates may apply. Reply STOP to end optional notification texts, START to resubscribe, or HELP for assistance. You may also manage optional SMS consent in your Prescience permissions or email support@getprescience.com. If your carrier blocks the Prescience sender after an opt-out, sign-in codes may remain unavailable until you reply START or contact support.

You are responsible for keeping the mobile number on your profile current and for access to that device. Delivery is subject to carrier availability and is not guaranteed. Do not use SMS for an emergency or include medical details in a reply. Call 911 or seek emergency care for a medical emergency. See the full SMS program disclosure at getprescience.com/sms.

Fees, funding obligations, payment timing, shared-savings terms, provider payment terms, banking instructions, and implementation charges are set forth in the applicable order form, statement of work, provider agreement, plan document, or other written agreement.

You authorize Prescience and its banking, card, payment, and processing partners to initiate, receive, or facilitate payments, transfers, card transactions, reimbursements, invoices, and related records as necessary for the services. Late, failed, reversed, or disputed payments may result in suspension, collection activity, or other remedies allowed by written agreement and law.

The services may interoperate with third-party providers, record networks, telehealth groups, banks, card issuers, payment processors, brokers, consultants, TPAs, PBMs, carriers, stop-loss partners, AI providers, analytics tools, and other vendors. Prescience is not responsible for third-party services that we do not control, except as required by law or a written agreement.

Prescience and its licensors own all rights in the platform, software, APIs, models, workflows, designs, documentation, branding, and content. Subject to these Terms and any written agreement, we grant you a limited, non-exclusive, non-transferable, revocable license to use the services during the applicable term for authorized purposes.

Feedback, suggestions, or ideas you provide may be used without restriction or compensation, but we will not disclose PHI or confidential information in doing so except as permitted by agreement and law.

We may suspend or limit access if we reasonably believe there is a security risk, unlawful activity, non-payment, misuse, inaccurate data, violation of these Terms, violation of a written agreement, or legal or regulatory risk. Termination rights, data return, data deletion, transition support, and survival terms may be governed by the applicable written agreement.

THE SERVICES ARE PROVIDED "AS IS" AND "AS AVAILABLE" WITHOUT WARRANTIES OF ANY KIND, WHETHER EXPRESS, IMPLIED, OR STATUTORY, INCLUDING WARRANTIES OF MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, TITLE, NON-INFRINGEMENT, AVAILABILITY, ACCURACY, AND SECURITY.

Information provided through the services is for operational and informational purposes and does not constitute medical, clinical, legal, tax, actuarial, fiduciary, insurance, financial, or compliance advice. Consult qualified professionals before making decisions in those areas.

TO THE MAXIMUM EXTENT PERMITTED BY LAW, PRESCIENCE AND ITS OFFICERS, DIRECTORS, EMPLOYEES, AGENTS, LICENSORS, AND PARTNERS WILL NOT BE LIABLE FOR INDIRECT, INCIDENTAL, SPECIAL, CONSEQUENTIAL, EXEMPLARY, OR PUNITIVE DAMAGES, OR FOR LOST PROFITS, LOST REVENUE, LOST DATA, LOSS OF GOODWILL, BUSINESS INTERRUPTION, OR COST OF SUBSTITUTE SERVICES.

TO THE MAXIMUM EXTENT PERMITTED BY LAW, OUR TOTAL LIABILITY FOR ANY CLAIM ARISING OUT OF OR RELATING TO THESE TERMS OR THE SERVICES WILL NOT EXCEED THE GREATER OF (A) AMOUNTS PAID TO PRESCIENCE FOR THE APPLICABLE SERVICE IN THE TWELVE MONTHS BEFORE THE EVENT GIVING RISE TO THE CLAIM OR (B) ONE HUNDRED U.S. DOLLARS ($100). A WRITTEN AGREEMENT MAY SET DIFFERENT LIABILITY TERMS.

You agree to defend, indemnify, and hold harmless Prescience from claims, damages, losses, liabilities, and expenses, including reasonable attorneys' fees, arising from your use of the services, your data, your violation of these Terms or a written agreement, your violation of law, or your violation of another person's rights. Written agreements may include additional or different indemnity terms.

These Terms are governed by the laws of the State of Delaware, without regard to conflict-of-law principles. Disputes will be resolved in the state or federal courts located in Delaware unless a written agreement or applicable law requires a different forum. You waive objections to jurisdiction and venue in those courts.

We may revise these Terms from time to time. Continued use of the services after revised Terms become effective constitutes acceptance of the revised Terms. We will indicate the latest revision date on this page. Material changes may also be communicated through the platform, email, or other reasonable notice.

Questions about these Terms may be sent to legal@getprescience.com.