AI & Automated Decision-Making Disclosure
Important: Our AI systems are designed to assist with understanding and utilizing health insurance benefits. They are not a substitute for professional medical advice, diagnosis, or treatment. Users should always consult qualified healthcare professionals for medical decisions and verify coverage information with their insurance carrier.
Introduction
This disclosure explains how Benefitly, LLC ("Benefitly," "we," "us," or "our") employs artificial intelligence, machine learning, and automated technologies in providing our services. By using Benefitly, you acknowledge and agree to the terms described in this document.
This disclosure is provided in compliance with the General Data Protection Regulation (GDPR), California Consumer Privacy Act (CCPA), and other applicable privacy laws.
What is Automated Decision-Making?
Automated decision-making occurs when technology makes decisions about you without meaningful human involvement. This includes:
- Profiling: Automated analysis of your personal information to evaluate, predict, or influence aspects of your behavior or preferences
- Algorithmic decisions: Decisions made by computer algorithms based on data analysis
- AI-powered recommendations: Suggestions generated by artificial intelligence systems
- Machine learning: AI that improves automatically through experience
- Natural language processing (NLP): Technology that enables computers to understand human language
How We Use AI & Automated Systems
1. Coverage Analysis and Benefit Identification
Our system automatically analyzes health insurance plan documents and identifies covered services, deductibles, copayments, and out-of-pocket maximums. It determines eligible benefits and calculates estimated healthcare costs by parsing plan documents.
Data used: Your insurance plan type and carrier, plan documents and coverage details, enrollment information, and any additional data you have provided.
Impact: Affects what benefit information is displayed to you, service recommendations, and cost estimates you receive.
The system may produce errors or incomplete information. Users should always confirm coverage details by reviewing their official plan documents or contacting their insurance company directly before making healthcare decisions.
2. Provider Matching and Recommendations
Our system matches you with in-network providers and ranks providers based on location, specialty, availability, and ratings. It filters out-of-network providers and suggests providers based on your needs and preferences.
Data used: Your location, insurance network, healthcare needs, provider specialties, and past provider interactions.
Impact: Determines which providers are shown to you and their order, influences the recommendations you receive, and may limit your view to in-network providers.
3. Underutilized Benefit Identification
Our system analyzes benefit usage patterns to identify unused covered services, predicts relevant benefits that may be valuable to you, and sends notifications about unused benefits.
Data used: Your coverage details, services you have searched for or accessed, demographic information, and aggregated usage patterns.
Impact: Determines the benefit recommendations you receive, influences notification content, and affects the educational content displayed to you.
Users may disable personalized recommendations at any time and can adjust notification preferences through their account settings.
4. Chatbot Responses and Guidance
Our system interprets your questions using natural language processing and generates responses based on your plan and our knowledge base. It provides step-by-step guidance and routes complex questions to human support while formulating personalized guidance based on your specific situation.
Data used: Your questions and conversation history, insurance plan details, previous chatbot interactions, and common question patterns.
Impact: Determines the responses to your questions, affects information accuracy and relevance, and influences when you are escalated to human support.
5. Account Security and Fraud Prevention
Our system monitors login attempts and account activity for suspicious patterns, flags unusual behavior, may restrict access if fraud is suspected, and requires additional verification for high-risk activities.
Data used: Login times and locations, device information, access patterns, failed login attempts, and comparison to your typical behavior.
Impact: May require additional authentication, can temporarily limit access to protect your account, and affects the security notifications you receive.
Our security team reviews all flagged accounts, and support can resolve issues quickly. False positives are corrected promptly, and users can verify their identity to restore access immediately.
6. Platform Personalization
Our system customizes your dashboard and interface, prioritizes information based on your usage patterns, suggests features you may find helpful, and adapts content to your preferences.
Data used: The features you use, time spent on the platform, your search and browsing patterns, and your configured preferences.
Impact: Affects the displayed content and its order, influences feature highlights, and shapes your overall user experience.
Users may customize their dashboard at any time, can reset to standard view, and can disable personalization entirely.
Your Rights
Right to Be Informed
You have the right to know when automated decision-making is used, what data is processed, the logic behind decisions, and the consequences of those decisions. This disclosure fulfills that right, and you may request additional information at any time by contacting us.
Right to Contest Decisions
You may disagree with automated recommendations, request reconsideration of any decision, provide additional context that the system may not have considered, or appeal decisions that affect your experience. To contest a decision, email support@benefitly.ai with details about the decision and any supporting information you wish to provide.
Right to Explanation
You may request an explanation of how an automated decision was made, what factors were considered in reaching that decision, and what data influenced the outcome. To request an explanation, you can use the relevant app feature, email support@benefitly.ai, or contact support through the platform.
Right to Data Portability
You may request a copy of the data used in automated decisions and transfer your data to another service. To request your data, you can use the "Export My Data" feature in your account settings or email privacy@benefitly.ai.
Right to Correct AI Errors
You may report errors in AI-generated content or recommendations at any time. To report an error, contact support@benefitly.ai. All reported errors will be reviewed and addressed within five business days.
Limitations & Disclaimers
What Our AI Can Do
- Explain insurance coverage in plain language
- Identify covered benefits under your plan
- Respond to questions about deductibles, copays, and out-of-pocket costs
- Guide users through benefit access processes
- Provide general information about healthcare services based on general statistics
What Our AI Cannot Do
Our AI does not: provide medical advice, diagnosis, or treatment; replace healthcare providers; guarantee coverage for specific services; override insurance company policies; predict future health outcomes; access complete medical records unless you specifically provide them; or make healthcare decisions on your behalf. Users retain full control over all healthcare choices.
Known Limitations
- Automated systems may not account for unique circumstances specific to your situation
- They can make errors and may not understand nuanced questions that require human judgment
- These systems cannot replace professional judgment in all cases
- They may be biased based on training data
- They cannot guarantee outcomes or perfectly predict all scenarios
User Responsibilities
- Verify all information with your insurance carrier before making important decisions
- Always consult healthcare professionals for medical decisions
- Use critical thinking when reviewing AI recommendations
- Report errors promptly to help us improve the system
- Request human review whenever you need additional assurance
- Provide accurate information to receive the best results
- Use the service for its intended purpose
- Do not attempt to manipulate or misuse the AI system
- Maintain your account security
Important: Benefitly's AI provides information about insurance coverage only and should not be relied upon for medical or legal advice. Users should consult qualified professionals for medical or legal guidance. Coverage analysis is based on available documents and may not reflect real-time changes made by your insurance carrier. Users are responsible for verifying coverage with their insurance carrier before receiving services.
Decisions Never Made by Automated Systems
The following decisions are never made solely by automated systems and always require human involvement or are made by external parties:
- Coverage denials: Can only be made by insurance carriers, not by Benefitly
- Medical diagnoses or treatment decisions: Never made by our system
- Healthcare decisions: Remain entirely under your control
- Account termination decisions: Made by human staff members
- Dispute resolution: Handled through human review processes
- Policy changes: Made by our leadership team with legal review
All final coverage decisions rest with your insurance carrier or provider, not with Benefitly or our AI systems.
Safeguards & Security
Quality & Fairness Safeguards
- Regular algorithm testing and validation to ensure accuracy
- Bias testing conducted to prevent discriminatory outcomes
- Human expert review required for all high-impact decisions
- Comprehensive documentation and reporting of algorithm logic
- Input data accuracy verification with regular updates
- Continuous learning and improvement through analysis of conversation patterns
- Regular audits to ensure compliance with insurance regulations
Security Measures
- All data encrypted both in transit and at rest using industry-standard encryption protocols
- Secure APIs with authentication to protect data transfers
- Regular security audits to identify and address vulnerabilities
- Strict access controls limit who can view or modify data
- Model security measures to prevent unauthorized manipulation
- Continuous monitoring for threats
- Bias mitigation protocols, error prevention systems, and harmful content prevention measures
- All AI decisions logged and reviewed for quality assurance purposes
Third-Party AI Services
Benefitly utilizes third-party AI services for infrastructure, analytics, and chatbot functionality. All third-party providers are contractually obligated to comply with HIPAA regulations and are prohibited from using data for non-service purposes. These providers are subject to the same security standards we maintain for our own systems.
Data Usage
Data Sources for Automated Decisions
Direct user input: Your health insurance plan details, questions submitted to the chatbot, healthcare preferences, feedback, and configured preferences.
From employers or insurance carriers: Plan documents, coverage details, network information, eligibility information, and claims history if authorized by you.
From third-party databases: Provider directories, health facility information, and cost data.
Automatically collected: Platform interaction data, device and browser information, usage patterns, features used and time spent, and search and browsing patterns.
Data We Do Not Use
Benefitly does not use the following for any automated decisions:
- Genetic information
- Race or ethnicity (except for bias testing to prevent discrimination)
- Political or religious beliefs
- Sexual orientation
- Union membership
- Social media activity outside the platform
Data Usage for AI Training and Improvement
Benefitly may use de-identified or aggregated data to improve AI accuracy, develop new features, analyze usage trends, and enhance system performance. All data used for these purposes is protected through encryption and strict access controls.
We retain data for a maximum of three years, and earlier deletion is available upon request. Users may opt out of data use for AI training and may request review or deletion of their data at any time by emailing support@benefitly.ai.
Updates & Changes
Benefitly may update automated decision-making systems to improve accuracy, add features, comply with regulations, or address issues that arise.
When we make material changes that affect how automated decisions are made or how your data is used, we will:
- Update this notice
- Send notification via in-app notification
- Provide information on the changes
- If applicable, offer opt-out options for new features or data uses
The current version of this disclosure is always available in your account settings and at www.benefitly.ai/ai-disclosure. Continued use of the service after updates are announced constitutes consent to the changes.
Contact & Support
Regulatory Complaints
You may also file complaints with the Federal Trade Commission (FTC), your state Attorney General, or if you are in the EU/EEA, your Data Protection Authority.
AI Technology Glossary
Artificial Intelligence (AI): Computer systems that perform tasks requiring human intelligence.
Machine Learning: AI that improves automatically through experience.
Natural Language Processing (NLP): Technology enabling computers to understand human language.
Algorithm: A set of rules or instructions that AI follows to make decisions.
Training Data: The information used to teach AI systems how to perform tasks.
De-identification: The process of removing personal identifiers from data.
Automated Decision-Making: Decisions made by AI without human intervention.
Bias: Systematic errors in AI outputs that may favor or disadvantage certain groups.
Confidence Score: A measure of how certain the AI is in its responses.
Profiling: The use of automated processing to evaluate personal aspects about an individual.
By using the Services, you acknowledge that you have read and understood this AI & Automated Decision-Making Disclosure, and you consent to the use of automated systems as described herein.