Amendment to Provider Agreement, dated December 21, 2018, by and among Anthem Insurance Companies, Inc. and Online Care Group P.C
[***] Certain information in this document has been omitted from this exhibit because it is both (i) not material and (ii) would be competitively harmful if publicly disclosed.
AMENDMENT TO PROVIDER AGREEMENT
This Amendment (the Amendment) to the Provider Agreement (Provider Agreement), by and between Anthem Insurance Companies, Inc. (hereafter referred to as Anthem) and Online Care Group PC (Provider) dated February 25, 2013, is effective December 21, 2018 (Effective Date). Provider and Anthem are sometimes referred to herein as a party or the parties.
WHEREAS, Provider is a California professional corporation that employs and/or contracts with physicians and other medical professionals (Participating Providers) to provide Covered Services; and
WHEREAS, Anthem desire to ensure that their Covered Individuals have the ability to gain prioritized access to Covered Services provided by Participating Providers via LiveHealth Online, a web-based communications system (the Platform);
NOW, THEREFORE, for good and valuable consideration, the receipt and legal sufficiency of which are hereby expressly acknowledged, the parties agree that the Provider Agreements shall be amended to incorporate the following:
Section 1. Services
In consideration of the payment of Access Fees (as defined below), Provider shall provide, and ensure that its Participating Providers provide, the following services:
(a) Availability of Participating Providers. Provider shall make available its Participating Providers, who are MDs, to Anthem in order to provide Covered Services to Covered Individuals on the Platform on a 24/7/365 basis during the term of this Amendment in each state listed on Exhibit A. Provider shall make available its Qualified Professionals, who are Social Workers, Psychologists, or Marriage and Family Therapists and Licensed Professional Counselors (collectively, Therapists) and Psychiatrists, to Anthem in order to provide Health Services to its Members on the Platform via scheduled visits during the term of this Amendment. Members will be offered an appointment time with a Therapist within 4 days of their request date, and an appointment time with a Psychiatrist within 14 days of their request date.
(b) Qualifications of Participating Providers. Throughout the term of this Amendment, all Participating Providers will maintain levels of medical malpractice insurance as required by law to provide Covered Services. Furthermore, all Physicians will, in addition to the requirements of the Provider Agreement, be: (i) licensed in the state in which the patient receiving Covered Services is located; (ii) certified by one or more of the American Board of Medical Specialties (ABMS), the AOA, the Royal College of Physicians and Surgeons of Canada (RCPSC), or the College of Family
Physicians of Canada (CFPC), Social Workers shall have a Master or doctoral degree in social work with emphasis in clinical social work from a program accredited by the Council on Social Work Education (CSWE) or the Canadian Association on Social Work Education (CASWE), Psychologists shall hold a PsyD, PhD, or EdD in clinical psychology or counseling psychology and have graduated from an American Psychological Association (APA) accredited doctoral program, and Marriage and Family Therapists and Licensed Professional Counselors shall have a Masters degree in an appropriate behavioral science or mental health discipline and have graduated from a school accredited by one of the Regional Institutional Accrediting Bodies and may be verified from the Accredited Institutions of Post-Secondary Education, APA, Council for Accreditation of Counseling and Related Educational Programs (CACREP), or Commission on Accreditation for Marriage and Family Therapy Education (COAMFTE) listings; (iii) credentialed in accordance with NCQAs CR1-8 standards, including verification of the Participating Providers licensure, board certification, malpractice history, disciplinary actions, highest level of education, work history, and other criteria as may be agreed upon from time to time by the parties, (iv) hold any state or federal registrations necessary to issue prescriptions, as applicable; and (v) trained in the provision of professional medical services in an online setting.
(c) Standards and Requirements. Throughout the term of this Amendment, Provider shall, in addition to the requirements of the Provider Agreement, require Participating Providers to: (i) provide Covered Services in a manner consistent with all accepted standards of professional practice; (ii) adhere to all ethical standards and requirements, local, state and federal laws and regulations; (iii) dress professionally and be located in a physical environment conducive to an effective, private conversation when providing the Covered Services; and (iv) maintain access to a supported computer and web browser, a high-speed internet connection (DSL, cable modem, T1) and web camera, all in accordance with the Platforms requirements.
In the event of any conflict or inconsistency between the terms set forth in Section 1 herein and those in the Provider Agreement, the terms in the Provider Agreement shall prevail and supersede any such inconsistent terms.
Section 2. Access Fee
Anthem will pay annual access fees to Provider for each calendar year of the term of this Amendment in the amounts set forth below. These payments shall be paid annually in advance on the dates set forth below:
December 21, 2018
December 15, 2019
December 15, 2020
December 15, 2021
Section 3. Plan Compensation Schedule
Effective January 1, 2020, the Plan Compensation Schedule is hereby amended such that Provider is reimbursed [***] per each Covered Service involving CPT Code 99444.
Section 4. No Solicitation
Unless otherwise agreed in writing, Anthem shall not hire, engage or solicit or attempt to hire, engage or solicit as an employee, contractor or otherwise any Participating Provider.
Section 5. Term and Termination
(a) Term. The term of this Amendment shall commence on the Effective Date and continue, unless terminated pursuant to Section 5(b), until December 31, 2022.
(b) Termination. Either party may terminate this Amendment if the other party materially breaches any terms or conditions, or fails to perform any obligation, under this Amendment and fails to cure such breach within thirty (30) days after receipt of written notice of such breach from the other party.
(c) Effect of Termination.
(i) In the event of termination of this Amendment, Provider shall be entitled to the fees earned by it for the Covered Services actually performed prior to the effective date of such termination.
(ii) In the event of termination of this Amendment, the parties shall, within 30 days of the effective date of termination, destroy or surrender and deliver to the Disclosing Party any and all originals and copies of Confidential Information in the Receiving Partys possession, custody or control at the time of such termination. Each party shall return Confidential Information in the format in which it was received from the other party.
Section 6. Miscellaneous
Except as expressly set forth in this Amendment the terms and conditions of the Provider Agreement including but not limited to the PCS, remain in effect. In the event of a conflict between the terms and conditions of this Amendment and the Provider Agreement, the Provider Agreement shall supersede this Amendment.
IN WITNESS WHEREOF, the parties to this Amendment have caused the same to be executed as of the Effective Date written above.
|Online Care Group P.C.|
|Name: Peter Antall, M.D.|
12/20/2018 | 1:09 PM PST
|Anthem Insurance Companies, Inc.|
|Name: Jim Ardell|
Title: VP, CRE & CPO
12/20/2018 | 2:18 PM PST
All 50 U.S. states (and Washington D.C.). Provider may change the states in which it provides services as a result of changes in the regulatory environment. Any such change will be effective upon Provider provision of notice of the same to Anthem.