eBenefits Client Work Order

AccountID

This Broker Work Order for CLIENT (the “Work Order”) is made and entered into effective (the “Work Order Effective Date”), by and between BenefitsApp Inc. (“BenefitsApp”) and Eastern Insurance (“BROKER”) pursuant to the Master RESELLER Agreement of dated February 23, 2023, (the “Master Agreement” on file with Eastern Insurance).

Today's Date

Work Order submission date.

Employer Group or Client Name

The company that will use BenefitsApp for their employees

Broker Contact

First NameLast Name

Broker Name and Location

Broker Email

example@example.com

Broker Phone Number

Please enter a valid phone number.

Client Point of Contact:

First NameLast Name

Client Email

example@example.com

Client Phone Number

Please enter a valid phone number.

The term of this Work Order shall be twelve (12) months from the Launch Date (the “Initial Term”), and shall thereafter automatically renew for successive one (1) year terms (each, a “Renewal Term”) unless either party gives written notice to the other party at least ninety (90) calendar days prior to the expiration of the then-current term of its intent not to renew the Work Order.

The Client may receive a copy of this work order and/or a Non-Disclosure Agreement (NDA) for their approval by signature prior to starting production.

Send Client Contact

Send Work Order and NDASend NDA onlyNo not send

BenefitsApp Annual License:*

Rate quoted to Client and will be their annual invoiced amount invoiced upon signed agreement.

BenefitsApp Per PMPM:*

Per Member Per Month rate quoted to Client and will be their annual, quarterly or monthly invoice for total number of users (e.g. total number of unique member IDs able to register and use BenefitsApp on their mobile phones)

Invoice PEPM*

Annually based on actual number of census member IDs (employees) on the launch date. Reviewed yearly on renewal. (Invoiced upon signed agreement)Monthly (Invoiced by 3rd day of each month)

Target Launch Date :

The launch date is the target date for release to employees.

Org Code:

Unique code for user registration. The Company code is a short form of the company name, for example "xcorp" for X Corporation or IBM for International Business Machines. BenefitsApp will confirm or assign the Org Code with the Client Contact

Census File to be provided?

YesNoUnsure

Estimated Number of Classes: (variations of benefit offerings, e.g. FT vs PT)

Does the employer group have one or more benefit guides? One for full-time vs part-time. Or variations among groups of employees?

Estimated Number of Users: (records per census file)

Employee, Employee + Spouse and/or Dependents to be included on the eligibility census file.

Expected Standard Administrators:

Number of Standard Administrators with access to employee personal information, self-service SMS and Push messaging features. No access to self-service reports. Reports are per request of BenefitsApp. One Standard Administrator is included with each license.

Expected HR Administrators:

Number of HR Administrators with full access to employee personal information, reports, self-service SMS and Push messaging features. $500/user license applies.

BenefitsApp Licensee: (receives invoices)*

BrokerClient

Accounts Payable Email:

If known, AP Email address for responsible party to receive a BenefitsApp invoice.

Invoice or Other Instructions:

Please provide instructions for billing and any other comments related to the client's BenefitsApp.

Additional Production and Messaging Fees:

Creative Production Management by BenefitsApp: $75/hour (push message development, marketing literature or other) for pre-approved creative production management.
SMS Fees: 10 messages per member per month included, $0.01 per message after 10 messages.
Push/In-App Fees: 10 messages per member per month included, $0.01 per message after 10 messages.

If available, please upload the most recent Benefits Guide and additional files for the BenefitsApp.

DO NOT UPLOAD CENSUS DATA HERE.

Please verify that you are human*

By submitting this signed Broker Client Work Order, the BenefitsApp team will review the BenefitsApp specification, and if everything is in order, BenefitsApp will send a Client Agreement with NDA for digital signature to your Client Contact's email.

Upon signature, BenefitsApp will send an Annual Invoice (Annual License + Annual PEPM if that option is checked) to the Accounts Payable Email address. Upon payment, the BenefitsApp team will engage the Client Contact for development and distribution of BenefitsApp to their employee members.

eBenefits Client Work Order

BenefitsApp Order Form: