# Contract with WellCare Insurance Co. for Healthllm

**Contract Date:** March 8, 2025
**Contract Number:** HL-2025-0021
**Parties:**
- Insurellm, Inc.
- WellCare Insurance Co.

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## Terms

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.

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.

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.

4. **Member Coverage**: Essential Tier supports health insurance administration for up to 15,000 covered members. Current enrollment: 11,000 members.

5. **Confidentiality:** Both parties agree to maintain strict confidentiality of proprietary information, protected health information (PHI), and member data in compliance with HIPAA regulations.

6. **HIPAA Compliance:** Insurellm operates as a Business Associate and maintains full HIPAA compliance including Business Associate Agreement (BAA).

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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## Renewal

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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## Features

WellCare Insurance Co. will receive the following Essential Tier features:

1. **Intelligent Plan Design:** AI-powered tools for creating competitive health plans:
   - Market trend analysis and competitive benchmarking
   - Member demographic analysis
   - Healthcare utilization pattern analysis
   - Benefit structure optimization
   - Deductible and copay modeling
   - Network configuration recommendations

2. **Real-Time Eligibility Verification:** Instant coverage verification:
   - Provider network integration for real-time checking
   - Member status validation
   - Coverage level confirmation
   - Dependent eligibility verification
   - Prior authorization status
   - Reduces claim denials due to eligibility issues

3. **AI-Driven Claims Adjudication:** Automated claims processing:
   - Machine learning-based claims review
   - Fraud detection and prevention
   - Payment accuracy verification
   - Auto-adjudication for clean claims
   - Denial management and appeals tracking
   - Learning from historical claim patterns

4. **Provider Network Management:** Comprehensive network administration:
   - Provider contract management
   - Credentialing and re-credentialing workflows
   - Network adequacy monitoring
   - Provider performance metrics
   - Contract negotiation analytics
   - Cost savings opportunity identification

5. **Member Engagement Platform:** Mobile-first member portal:
   - Digital ID cards
   - Claims status tracking
   - Provider directory search
   - Coverage information access
   - Telehealth service integration
   - Push notifications for preventive care

6. **Basic Medication Management:**
   - Formulary management tools
   - Prior authorization workflows
   - Generic substitution recommendations
   - Drug interaction checking
   - Medication adherence tracking

7. **Regulatory Compliance Engine:**
   - ACA (Affordable Care Act) compliance monitoring
   - State mandate tracking
   - HIPAA privacy and security compliance
   - Automated regulatory reporting
   - Form filing and approval tracking

8. **Standard Analytics:** Dashboards tracking:
   - Claims volume and processing time
   - Medical loss ratio (MLR)
   - Member satisfaction scores
   - Provider network utilization
   - Cost per member per month (PMPM)

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## Support

Insurellm commits to providing comprehensive support to WellCare Insurance Co.:

1. **Onboarding:** 4-week implementation program including:
   - System configuration for WellCare's plan designs
   - Training for up to 15 staff members (30 hours total)
   - Integration with existing systems (policy admin, provider network)
   - Data migration for current 11,000 members
   - Provider network data import and validation

2. **Technical Support:**
   - Email and phone support Monday-Friday 7 AM - 7 PM EST
   - Response time: 8 hours for critical issues, 24 hours for standard
   - Online ticketing system with status tracking
   - Knowledge base and FAQ library
   - Video tutorials and user guides

3. **Platform Updates:**
   - Quarterly feature releases with new capabilities
   - Monthly security patches and bug fixes
   - Regulatory compliance updates as laws change
   - Release notes and upgrade documentation
   - Advance notice of updates (minimum 21 days)

4. **Account Management:**
   - Named customer success manager
   - Quarterly business review meetings
   - Usage analytics and optimization recommendations
   - Industry trends and best practices sharing
   - Assistance with tier upgrade evaluation

5. **Compliance Support:**
   - Annual HIPAA compliance review
   - Regulatory update notifications
   - State insurance department filing assistance
   - ACA reporting support (1095 forms)
   - Audit preparation assistance

6. **Integration Support:** Technical assistance connecting Healthllm with:
   - Existing policy administration systems
   - Provider credentialing systems
   - Pharmacy benefit managers (PBMs)
   - Clearinghouses for EDI transactions
   - Member portal and mobile apps

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**Signatures:**

_________________________________
**Sarah Chen**
**Title**: Vice President of Sales
**Insurellm, Inc.**
**Date**: March 8, 2025

_________________________________
**Dr. Raymond Foster**
**Title**: Chief Medical Officer & COO
**WellCare Insurance Co.**
**Date**: March 8, 2025

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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.