Updated Week 5 with November version
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Edward Donner
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# Contract with WellCare Insurance Co. for Healthllm
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**Contract Date:** March 8, 2025
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**Contract Number:** HL-2025-0021
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**Parties:**
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- Insurellm, Inc.
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- WellCare Insurance Co.
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---
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## Terms
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1. **Coverage:** Insurellm agrees to provide WellCare Insurance Co. with access to the Healthllm platform, enabling comprehensive health insurance operations including plan design, eligibility verification, claims adjudication, and member engagement.
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2. **Duration:** This agreement is effective for a period of 12 months from the contract date, with automatic renewal unless terminated with 30-day written notice.
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3. **Payment:** WellCare Insurance Co. shall pay a monthly fee of $8,000, due by the 1st of every month for the Essential Tier package.
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4. **Member Coverage**: Essential Tier supports health insurance administration for up to 15,000 covered members. Current enrollment: 11,000 members.
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5. **Confidentiality:** Both parties agree to maintain strict confidentiality of proprietary information, protected health information (PHI), and member data in compliance with HIPAA regulations.
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6. **HIPAA Compliance:** Insurellm operates as a Business Associate and maintains full HIPAA compliance including Business Associate Agreement (BAA).
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7. **Liability:** Insurellm's liability is limited to direct damages not exceeding the total fees paid in the preceding 12 months.
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---
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## Renewal
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Unless either party provides written notice of termination at least 30 days prior to contract expiration, this agreement automatically renews for successive 12-month terms. Pricing may be adjusted annually with 60 days' advance notice, capped at 10% increase per year.
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---
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## Features
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WellCare Insurance Co. will receive the following Essential Tier features:
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1. **Intelligent Plan Design:** AI-powered tools for creating competitive health plans:
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- Market trend analysis and competitive benchmarking
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- Member demographic analysis
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- Healthcare utilization pattern analysis
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- Benefit structure optimization
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- Deductible and copay modeling
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- Network configuration recommendations
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2. **Real-Time Eligibility Verification:** Instant coverage verification:
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- Provider network integration for real-time checking
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- Member status validation
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- Coverage level confirmation
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- Dependent eligibility verification
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- Prior authorization status
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- Reduces claim denials due to eligibility issues
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3. **AI-Driven Claims Adjudication:** Automated claims processing:
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- Machine learning-based claims review
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- Fraud detection and prevention
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- Payment accuracy verification
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- Auto-adjudication for clean claims
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- Denial management and appeals tracking
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- Learning from historical claim patterns
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4. **Provider Network Management:** Comprehensive network administration:
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- Provider contract management
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- Credentialing and re-credentialing workflows
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- Network adequacy monitoring
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- Provider performance metrics
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- Contract negotiation analytics
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- Cost savings opportunity identification
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5. **Member Engagement Platform:** Mobile-first member portal:
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- Digital ID cards
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- Claims status tracking
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- Provider directory search
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- Coverage information access
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- Telehealth service integration
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- Push notifications for preventive care
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6. **Basic Medication Management:**
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- Formulary management tools
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- Prior authorization workflows
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- Generic substitution recommendations
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- Drug interaction checking
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- Medication adherence tracking
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7. **Regulatory Compliance Engine:**
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- ACA (Affordable Care Act) compliance monitoring
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- State mandate tracking
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- HIPAA privacy and security compliance
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- Automated regulatory reporting
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- Form filing and approval tracking
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8. **Standard Analytics:** Dashboards tracking:
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- Claims volume and processing time
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- Medical loss ratio (MLR)
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- Member satisfaction scores
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- Provider network utilization
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- Cost per member per month (PMPM)
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---
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## Support
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Insurellm commits to providing comprehensive support to WellCare Insurance Co.:
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1. **Onboarding:** 4-week implementation program including:
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- System configuration for WellCare's plan designs
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- Training for up to 15 staff members (30 hours total)
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- Integration with existing systems (policy admin, provider network)
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- Data migration for current 11,000 members
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- Provider network data import and validation
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2. **Technical Support:**
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- Email and phone support Monday-Friday 7 AM - 7 PM EST
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- Response time: 8 hours for critical issues, 24 hours for standard
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- Online ticketing system with status tracking
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- Knowledge base and FAQ library
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- Video tutorials and user guides
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3. **Platform Updates:**
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- Quarterly feature releases with new capabilities
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- Monthly security patches and bug fixes
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- Regulatory compliance updates as laws change
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- Release notes and upgrade documentation
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- Advance notice of updates (minimum 21 days)
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4. **Account Management:**
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- Named customer success manager
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- Quarterly business review meetings
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- Usage analytics and optimization recommendations
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- Industry trends and best practices sharing
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- Assistance with tier upgrade evaluation
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5. **Compliance Support:**
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- Annual HIPAA compliance review
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- Regulatory update notifications
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- State insurance department filing assistance
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- ACA reporting support (1095 forms)
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- Audit preparation assistance
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6. **Integration Support:** Technical assistance connecting Healthllm with:
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- Existing policy administration systems
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- Provider credentialing systems
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- Pharmacy benefit managers (PBMs)
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- Clearinghouses for EDI transactions
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- Member portal and mobile apps
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---
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**Signatures:**
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_________________________________
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**Sarah Chen**
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**Title**: Vice President of Sales
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**Insurellm, Inc.**
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**Date**: March 8, 2025
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_________________________________
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**Dr. Raymond Foster**
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**Title**: Chief Medical Officer & COO
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**WellCare Insurance Co.**
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**Date**: March 8, 2025
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---
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This agreement enables WellCare Insurance Co. to modernize their health insurance operations with AI-powered technology while ensuring regulatory compliance and improved member outcomes.
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