How will insurance carriers know we are transitioning our ICHRA to benefitbay?

[Date]

Effective, [Month/Day, Year] [Employer Name] has appointed benefitbay Insurance Agency LLC (NPN 20879773), Hunter Foster (NPN 21106661) and Ryan Argotsinger (NPN 19756882) as our ICHRA technology broker of record for individual coverage for applicable Health Plan Agreements with our employee members. The previous technology provider [Current TPA] agreement will terminate effectively [Month/Day, Year]. Broker compensation will be paid to benefitbay Insurance Agency LLC. The effective date of this letter will serve as authorization to provide benefitbay with any information they may request concerning the operation and evaluation of our plan. The proper movement of fiduciary responsibility to the benefitbay individual payment accounts established on behalf of our employees and your members. This notice supersedes any previous notifications and will remain in effect until notified in writing or termination of the Subscriber Individual Plan with your organization.

[Signature]

[Signer name]

[Company]