Lincoln Kickoff

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Comments

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This intake form will be used to produce your Enrollment Meeting on Demand™ and build your company Hub.

Please have the following information ready:

Client, Broker, and Contact Details.
Benefit summaries or carrier quotes in individual file format.
SBC's, Slip sheets, Compliance documents, handbooks, or other employee facing materials you would like readily available and in Sherps Knowlege base.
You can leave this form at any time—your progress will be saved automatically.
Broker and client logo.

Offered Lines of Coverage*

Enrollment matters, please notate which lines are "New" this plan year and Sherp™ will make sure to point this out to employees at open enrollment to make sure they understand the details!

Tuition Reimbursement Vendor*

Vendor Name*

Pet Insurance Vendor*

Vendor Name*

Identity Theft Vendor*

Vendor Name*

Legal Insurance Vendor*

Vendor Name*

EAP Vendor*

Vendor Name*

ICHRA Vendor*

Vendor Name*

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Marked Lines of Coverage

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Employer Paid New Lines of Coverage

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Voluntary New Lines of Coverage

Broker Agency Detail

The contact you enter here will be the individual responsible for completing the intake form.

Broker Agency Name*

Broker Web Address*

Agency Contact Name*

Agency Contact Role

Agency Contact Email*

Broker Office Phone*

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Broker Mobile

Broker Admin Support Contact Name*

Broker Support Phone*

Broker Admin Support Contact Email*

Broker Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Send Proofing Form to*

The proofing form will follow this submission in about 15 minutes, please select who you would like to complete this step.

Broker

Admin

Both

Send Handoff Email to*

The handoff email contains the link to your clients Hub, all the video assets and access to setup the SMS automation for open enrollment.

Broker

Admin

Both

Projected open enrollment window *

The proposed enrollment window is used to schedule the Open Enrollment launch and allows Sherp to communicate key deadlines to employees. Please note, the Hub will remain in Open Enrollment mode for the full renewal month. After this period, Sherp’s greeting will transition to general support.

Start Date*

Start Date

End Date*

End Date

What enrollment platform is this group using?*

Please provide the link where employees will log into their enrollment portal*

Broker logo*

Please upload your broker logo for proper branding

Drop files here or

Accepted file types: jpg, png, jpeg, webp, Max. file size: 10 MB, Max. files: 1.

Client Info

Company Name*

Benefit Renewal Month*

Company Website Link*

Company Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Company Logo*

Please upload your client logo for proper branding.

Drop files here or

Accepted file types: jpg, png, jpeg, webp, Max. file size: 10 MB, Max. files: 1.

Does this group have Spanish speaking needs?

Additional languages

HR Contact Info

HR Contact*

HR Email*

HR Phone*

When Sherp™ engages with employees, at times he needs to bring in human support. With the employees permission, he will share a summary of the employees need along with basic contact information. Please select who should receive these communications:

HR Only

HR & Broker

Broker Only

Eligibility & Structure

Benefit Plan Eligibility

Waiting Period for Full Time

Waiting Period for Part Time

Is coverage available to spouses or dependent children?

Would you like to include a COBRA notice in your video after the program eligibility section?

Some HR leads choose to exclude this from their EMOD video and handle COBRA communications separately.

Benefit Plan Detail

Please upload all the benefit summaries you wish to have reviewed in your Enrollment Meeting on Demand™.

Please upload only one document per plan type, and note that benefit summaries are preferred over medical SBC's. The compliance upload below is where SBC's should be uploaded. If medical benefit summaries are not available, you can upload the SBC's here ( not preferred ).

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Total number of medical plans

Medical Plan 1 Contains

If your prescription benefit summary is separate from the medical plan summary, please select this option to tie them together and upload accordingly.

Medical Plan 1 Benefit Summary*

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 100 MB, Max. files: 1.

Prescription Benefit for Medical Plan 1*

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 100 MB, Max. files: 1.

Medical Plan 2 Contains

If your prescription benefit summary is separate from the medical plan summary, please select this option to tie them together and upload accordingly.

Medical Plan 2 Benefit Summary*

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 100 MB, Max. files: 1.

Prescription Benefit for Medical Plan 2*

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 100 MB, Max. files: 1.

Medical Plan 3 Contains

If your prescription benefit summary is separate from the medical plan summary, please select this option to tie them together and upload accordingly.

Medical Plan 3 Benefit Summary*

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 100 MB, Max. files: 1.

Prescription Benefit for Medical Plan 3*

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 100 MB, Max. files: 1.

Medical Plan 4 Contains

If your prescription benefit summary is separate from the medical plan summary, please select this option to tie them together and upload accordingly.

Medical Plan 4 Benefit Summary*

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 100 MB, Max. files: 1.

Prescription Benefit for Medical Plan 4*

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 100 MB, Max. files: 1.

Do you have more than one benefit class?*

Yes

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Total Benefit Classes

Class 1

Upload Benefits

Upload All Non-Medical Benefit Plans

Please upload benefit summaries for all non-medical plans. Include every plan offered to employees such as Dental, Vision, Life, Disability, Accident, Critical Illness, Hospital Indemnity, Worksite, and similar benefits.

These files allow our system to automatically generate your benefit hub and enrollment meeting content.

To ensure accurate AI processing:

Upload each plan as a separate file
If multiple plans exist within a category (for example, two Dental plans), upload each plan separately
Quotes may be uploaded if final summaries are not available — please still upload one plan per file

Example uploads: Dental PPO.pdf, Dental DHMO.pdf, Vision Plan.pdf, Employer Paid Life.pdf, Voluntary Life.pdf

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 100 MB.

Class 2

Class Name*

Please upload only the specific benefit summaries for this separate class of employees. Do not upload the benefit summaries already included in Class 1 that overlap.

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 100 MB.

Class 3

Class Name*

Please upload only the specific benefit summaries for this separate class of employees. Do not upload the benefit summaries already included that overlap.

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 100 MB.

Class 4

Class Name*

Please upload only the specific benefit summaries for this separate class of employees. Do not upload the benefit summaries already included Please upload only the specific benefit summaries for this separate class of employees. Do not upload the benefit summaries already included in Class 1 that overlap.

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 100 MB.

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Click to upload files here

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 100 MB.

Healthcare Cost Sharing Programs in Place (HRA/HSA/FSA/DCA/Parking & Transit)

Please indicate which cost sharing benefit programs are currently active and funded by your employer group. This information helps us tailor communication templates that reflect the programs available to your employees. You’ll have the opportunity to review and edit each message before it’s shared on your proofing form.

Check all that apply:

Select Vendor

Health Reimbursement Arrangement (HRA)

Vendor: HRA*

Health Savings Account (HSA) – Employer Sponsored

Vendor: Health Savings Account (HSA) – Employer Sponsored*

Health Savings Account (HSA) – Employee Funded

Vendor: Health Savings Account (HSA) – Employee Funded*

Flexible Spending Account (FSA)

Vendor: Flexible Spending Account (FSA)*

Limited Purpose Flexible Spending Account (LPFSA)

Vendor: Limited Purpose Flexible Spending Account (LPFSA)*

Dependent Care Account (DCA)

Vendor: Dependent Care Account (DCA)*

Parking & Transit (Commuter Benefits)

Vendor: Parking & Transit (Commuter Benefits)*

401(k) Retirement Plan

Vendor: 401(k) Retirement Plan*

Compliance and Company Document Upload

Please upload any SBC's and additional non-benefit related documents that you would like housed on your Benefit Hub and made available to employees. Include any compliance, plan documents, current benefits guide and company policy documents here.

Click to upload files, or drag & drop files here

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 100 MB.

Important Contacts:

Please upload all contact information that should be provided to employees during the Enrollment Meeting on Demand. This includes carrier contacts, web URLs, email addresses, phone numbers, and any other contacts that employees may need to utilize.

Contact Sheet*

Contact Sheet Values

Contact

Name

Phone

Website

Can you please provide your health carrier's network provider search link?

Poster Style

Now that we have your benefit plan details, it's time to select your poster style to direct employees to their benefit hub at open enrollment and year round. Printable copies in both 8.5" x 11" and 11" x 17" formats will be included in the handoff email. If you have Spanish-speaking employees, Spanish versions will be included as well.

Poster Style*

Terms & Conditions:

These Terms & Conditions govern the use of O’Eme’s platform, including intake, AI-assisted content generation, proofing, Benefits Hub deployment, and ongoing employee communication tools.

1. Submission & Accuracy of Materials

By submitting information through O’Eme’s platform, you confirm that all benefit summaries, plan documents, eligibility rules, and related materials are accurate, complete, and current.

These materials are the sole basis for all generated communication content.

2. AI-Assisted Content Generation

O’Eme utilizes artificial intelligence tools, including:

EMOD™ Script Generation (dual-model AI-assisted drafting and validation)
Sherp™ AI Assistant (retrieval-based informational support)

AI-generated outputs are designed to improve efficiency and consistency but rely entirely on the materials provided.

Script outputs are considered draft content until reviewed and approved through the proofing process.

3. Proofing & Review Process (Required)

Prior to production:

A proofing form will be provided
96 hours are allotted for review and edits
A reminder will be sent at 72 hours
If no response is received within 96 hours, content is deemed approved
Post-deadline revisions may require reprocessing and may incur a $295 fee

4. Broker Responsibility & Approval

By proceeding, you acknowledge that:

You are responsible for reviewing all script content
You will reference supporting documentation (including SBCs and benefit summaries)
You approve final content as accurate and appropriate for employee communication

O'Eme does not independently verify plan details and does not assume responsibility for final content accuracy or plan interpretation

5. EMOD™ Content Ownership & Use

All EMOD™ scripts, videos, and related materials are proprietary to O'Eme, LLC.

These materials may not be copied, reproduced, distributed, modified, or repurposed outside of their intended use without prior written consent.

EMOD™ content includes repeated disclosures, presented in varied language, reinforcing that:

All benefit information is for educational purposes only. Official plan documents, including Summary of Benefits and Coverage (SBCs), govern in all cases.

6. Sherp™ AI Assistant — Capabilities & Limitations

Sherp™ is an AI-powered benefits communication assistant designed to help employees understand and navigate available benefit plans.

Sherp can:

Answer common benefit-related questions
Explain plan features and cost-sharing
Help employees identify or confirm plans based on user input
Provide general guidance for common benefit-related challenges

Sherp does not:

Have access to employee enrollment data
Know plan elections unless provided by the user
Confirm coverage or guarantee eligibility
Authorize or adjudicate claims
Provide legal, financial, or medical advice

7. Sherp™ Escalation & Support Handoff

When needed, Sherp™ can facilitate escalation by:

Summarizing the employee's request
Collecting contact information (name, date of birth, email, phone)
Requesting user acknowledgment and consent prior to sharing

Information is shared only as necessary to facilitate follow-up with HR or the broker

8. Benefits Hub — Access, Branding & Use

The Benefits Hub is a proprietary platform developed by O'Eme and branded for the broker or employer.

Designed for ease of access by employees and dependents
May be publicly accessible by default
Does not require login or authentication

The Hub:

Contains informational content only
Does not store sensitive personal or protected health information
Is not a system of record

Clients may request optional access controls (DNS, CNAME, intranet) via support@oeme.io.

9. Enrollment & Data Separation

All benefit enrollments are completed through each employer’s designated enrollment platform, where employees authenticate and enroll directly. O’Eme does not collect, process, or store employee enrollment elections and is not a system of record for benefit data.

10. Data Use & Privacy

O'Eme does not:

Sell employee data
Use Sherp interactions for marketing or profiling
Share individual conversations in detail

O'Eme may collect limited, aggregated data, including:

Usage activity
Satisfaction feedback
Interaction trends

This data is used solely for platform improvement and reporting.

11. SMS Communications (A2P Compliance)

When SMS services are used:

Contact data is provided by the employer or broker
Messages are sent in compliance with A2P requirements
Opt-out instructions are included in all communications

You confirm that employees have consented to receive employer-related communications.

12. Platform Role & Limitations

O'Eme operates as a benefits communication platform and does not:

Provide legal, financial, or medical advice
Act as a system of record
Replace licensed professionals

Licensed brokers and HR teams remain responsible for:

Plan interpretation
Employee guidance
Final communication accuracy

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Acknowledgment & Acceptance*

I acknowledge and accept these Terms & Conditions, including responsibility for the accuracy of submitted materials and the required review and approval of all communication content prior to production.

Acknowledgment & Acceptance*

These Terms & Conditions govern the use of O’Eme’s platform, including intake, AI-assisted content generation, proofing, Benefits Hub deployment, and ongoing employee communication tools.

1. Submission & Accuracy of Materials

By submitting information through O’Eme’s platform, you confirm that all benefit summaries, plan documents, eligibility rules, and related materials are accurate, complete, and current.

These materials are the sole basis for all generated communication content.

Liability & Indemnification

O'Eme provides the platform on an "as-is" basis. You agree to defend and indemnify O'Eme against claims arising from inaccurate materials you provided or your failure to review and approve content.

2. AI-Assisted Content Generation

O’Eme utilizes artificial intelligence tools, including:

EMOD™ Script Generation (dual-model AI-assisted drafting and validation)
Sherp™ AI Assistant (retrieval-based informational support)

AI-generated outputs are designed to improve efficiency and consistency but rely entirely on the materials provided.

Script outputs are considered draft content until reviewed and approved through the proofing process.

3. Proofing & Review Process (Required)

Prior to production:

A proofing form will be provided
96 hours are allotted for review and edits
A reminder will be sent at 72 hours
If no response is received within 96 hours, content is deemed approved
Post-deadline revisions may require reprocessing and may incur a $295 fee

4. Broker Responsibility & Approval

By proceeding, you acknowledge that:

You are responsible for reviewing all script content
You will reference supporting documentation (including SBCs and benefit summaries)
You approve final content as accurate and appropriate for employee communication

O'Eme does not independently verify plan details and does not assume responsibility for final content accuracy or plan interpretation

5. EMOD™ Content Ownership & Use

All EMOD™ scripts, videos, and related materials are proprietary to O'Eme, LLC.

These materials may not be copied, reproduced, distributed, modified, or repurposed outside of their intended use without prior written consent.

EMOD™ content includes repeated disclosures, presented in varied language, reinforcing that:

All benefit information is for educational purposes only. Official plan documents, including Summary of Benefits and Coverage (SBCs), govern in all cases.

6. Sherp™ AI Assistant — Capabilities & Limitations

Sherp™ is an AI-powered benefits communication assistant designed to help employees understand and navigate available benefit plans.

Sherp can:

Answer common benefit-related questions
Explain plan features and cost-sharing
Help employees identify or confirm plans based on user input
Provide general guidance for common benefit-related challenges

Sherp does not:

Have access to employee enrollment data
Know plan elections unless provided by the user
Confirm coverage or guarantee eligibility
Authorize or adjudicate claims
Provide legal, financial, or medical advice

7. Sherp™ Escalation & Support Handoff

When needed, Sherp™ can facilitate escalation by:

Summarizing the employee's request
Collecting contact information (name, date of birth, email, phone)
Requesting user acknowledgment and consent prior to sharing

Information is shared only as necessary to facilitate follow-up with HR or the broker

8. Benefits Hub — Access, Branding & Use

The Benefits Hub is a proprietary platform developed by O'Eme and branded for the broker or employer.

Designed for ease of access by employees and dependents
May be publicly accessible by default
Does not require login or authentication

The Hub:

Contains informational content only
Does not store sensitive personal or protected health information
Is not a system of record

Clients may request optional access controls (DNS, CNAME, intranet) via support@oeme.io.

9. Enrollment & Data Separation

10. Data Use & Privacy

O'Eme does not:

Sell employee data
Use Sherp interactions for marketing or profiling
Share individual conversations in detail

O'Eme may collect limited, aggregated data, including:

Usage activity
Satisfaction feedback
Interaction trends

This data is used solely for platform improvement and reporting.

11. SMS Communications (A2P Compliance)

When SMS services are used:

Contact data is provided by the employer or broker
Messages are sent in compliance with A2P requirements
Opt-out instructions are included in all communications

You confirm that employees have consented to receive employer-related communications.

12. Platform Role & Limitations

O'Eme operates as a benefits communication platform and does not:

Provide legal, financial, or medical advice
Act as a system of record
Replace licensed professionals

Licensed brokers and HR teams remain responsible for:

Plan interpretation
Employee guidance
Final communication accuracy

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Submitted by:*

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Parent entry id

If this form is refilled by broker then this is the id of entry from which it is getting filled.

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Child entry id

If this form has been used for filling the a new form by broker then this contains the entry id of that form.

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Unique ID

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Benefit Hub QR Code English

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Benefit Hub QR Code Spanish

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Partner Name

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English Website Slug

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Spanish Website Slug

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Uploaded to S3

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Intake Form

This intake form will be used to produce your Enrollment Meeting on Demand™ and build your company Hub.

Broker Agency Detail

Projected open enrollment window *

Client Info

HR Contact Info

Eligibility & Structure

Benefit Plan Detail

Healthcare Cost Sharing Programs in Place (HRA/HSA/FSA/DCA/Parking & Transit)

Compliance and Company Document Upload

Important Contacts:

Poster Style

Terms & Conditions:

1. Submission & Accuracy of Materials

2. AI-Assisted Content Generation

3. Proofing & Review Process (Required)

4. Broker Responsibility & Approval

5. EMOD™ Content Ownership & Use

6. Sherp™ AI Assistant — Capabilities & Limitations

7. Sherp™ Escalation & Support Handoff

8. Benefits Hub — Access, Branding & Use

9. Enrollment & Data Separation

10. Data Use & Privacy

11. SMS Communications (A2P Compliance)

12. Platform Role & Limitations

1. Submission & Accuracy of Materials

Liability & Indemnification

2. AI-Assisted Content Generation

3. Proofing & Review Process (Required)

4. Broker Responsibility & Approval

5. EMOD™ Content Ownership & Use

6. Sherp™ AI Assistant — Capabilities & Limitations

7. Sherp™ Escalation & Support Handoff

8. Benefits Hub — Access, Branding & Use

9. Enrollment & Data Separation

10. Data Use & Privacy

11. SMS Communications (A2P Compliance)

12. Platform Role & Limitations