Compliance
How ClariFi's plans are structured, what documentation you get, and how employee health and payment data is protected.
ClariFi is not an insurance company. ClariFi is a technology and administrative services platform that employers use to run a self-funded direct reimbursement dental benefit. The employer, not ClariFi, is the plan sponsor.
Plan Structure
A direct reimbursement plan set up through ClariFi is typically an employer-sponsored, self-funded welfare benefit plan, and in most cases this makes it subject to ERISA, the federal law governing employer-sponsored benefit plans. ERISA treatment carries plan document, reporting, and fiduciary obligations. Whether a specific plan is subject to ERISA, and what that means for annual filing requirements such as Form 5500, depends on plan structure and employer type (for example, church and government plans are commonly exempt). Employers should confirm their plan's specific obligations with their own benefits counsel or ERISA attorney. ClariFi supports the administrative side of this, including generating the plan document and summary plan description (SPD) for your plan, but does not provide legal advice.
What ClariFi Generates for Your Plan
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A plan document and summary plan description (SPD) reflecting your chosen reimbursement schedule and annual maximum.
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Ongoing reporting on plan spend and utilization, exportable for finance, HR, and brokers.
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Claim-level records supporting whatever filing your plan requires, prepared in partnership with your benefits counsel.
HIPAA and Data Security
ClariFi handles employee health and payment data as part of administering claims, and complies with HIPAA and HITECH requirements for that data, using:
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Encrypted data storage and transmission
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Audited, secure cloud infrastructure
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Role-based access control
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Routine security testing
Fraud Prevention and Claim Validation
Virtual payment cards are restricted to dental providers, and claims are validated against ADA procedure codes in real time, with automated monitoring for unusual billing patterns and the ability to freeze a card instantly if misuse is suspected. This is what keeps a card-based direct reimbursement plan auditable without manual claims review.
Read Next
For the plan mechanics this compliance structure supports, see how a direct reimbursement dental plan works. For how ClariFi handles your data more broadly, see the Privacy Policy.
Have a Specific Compliance Question?
Talk to our team about your plan's documentation and reporting needs.