United Care Fund Specification

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United Care Fund

Together, We Can Afford Better Healthcare.

United Care Fund is an open specification for creating a cooperative healthcare funding system in which participating businesses work together to finance healthcare, increase collective purchasing power, reduce unnecessary costs, and provide better access to affordable care without a profit objective.

The specification is designed to allow businesses to determine which healthcare expenses and benefits they will cover while maintaining a shared foundation of basic healthcare coverage. The system uses healthcare cost intelligence, treatment pathway modeling, cooperative purchasing, claims administration, conservative fund management, and transparent governance to help participating businesses make informed healthcare funding decisions.

Purpose

United Care Fund is designed to provide a modular framework for organizations that want to create or participate in a cooperative approach to healthcare financing.

The system should:

Pool healthcare funding among participating businesses according to defined rules.
Reduce unnecessary healthcare costs through collective purchasing and cost transparency.
Preserve medically appropriate care while targeting waste, excessive administrative expenses, inefficient intermediaries, and noncompetitive pricing.
Allow participating businesses to select additional healthcare benefits according to their needs and applicable law.
Provide a common base level of healthcare coverage for eligible participants.
Estimate healthcare costs using real-world pricing, utilization, and treatment pathways.
Process medical expense submissions and reimbursements.
Maintain adequate operating, claims, emergency, and catastrophic reserves.
Manage cooperative funds with a capital preservation and liquidity priority.
Provide transparent financial, healthcare, and governance information.
Maintain human oversight over important healthcare, financial, regulatory, and governance decisions.
Support annual recalculation of healthcare costs and funding requirements.
Remain modular so organizations can adopt only the capabilities appropriate to their cooperative.

Core Principles

Cooperative Healthcare Funding

The system shall operate as a cooperative healthcare funding framework rather than a profit-driven healthcare business.

Participating businesses contribute funds according to established contribution rules. Those funds are used to pay eligible healthcare expenses, maintain appropriate reserves, administer the cooperative, and support other legally permitted cooperative purposes.

The system should prioritize healthcare value and affordability over financial profit.

No Profit Objective

The cooperative shall not be designed around maximizing profit from healthcare funding.

Funds should be allocated toward:

Eligible healthcare expenses.
Administrative expenses.
Required reserves.
Catastrophic protection.
Legitimate cooperative operating expenses.
Future healthcare obligations.
Potential contribution reductions when financially appropriate.
Potential expansion of benefits when financially sustainable.

Any surplus should remain subject to the cooperative’s governing documents, applicable law, and approved financial policies.

Cost Reduction Without Cutting Corners

Cost reduction shall prioritize eliminating unnecessary expenses rather than reducing medically appropriate care.

The system should identify opportunities involving:

Excessive provider pricing.
Administrative waste.
Unnecessary intermediaries.
Duplicate services.
Billing errors.
Preventable complications.
Inefficient purchasing.
Noncompetitive contracts.
Excessive prescription costs.
Avoidable emergency utilization.
Poorly coordinated care.
Unnecessary administrative overhead.

Cost reduction should not be achieved by automatically denying medically appropriate treatment or shifting unreasonable costs to employees.

Local and Jurisdiction Aware Operation

The system shall recognize that healthcare funding arrangements can be subject to different laws and regulatory classifications depending on jurisdiction and organizational structure.

The system shall not assume that every cooperative healthcare fund is legally identical.

Regulatory analysis shall be performed before implementation and whenever the cooperative changes its structure, benefits, funding model, membership, or geographic scope.

Human Control

AI may analyze information, identify patterns, estimate costs, model scenarios, detect anomalies, and make recommendations.

AI shall not independently make final decisions concerning:

Individual claim denials.
Medically appropriate care.
Major benefit changes.
Investment transactions.
Regulatory classifications.
Legal conclusions.
Major financial commitments.
Provider contracts.
Governance decisions.

Human reviewers shall retain authority over consequential decisions.

Core Modules

Cooperative Formation Module

The Cooperative Formation Module defines the rules for establishing and operating a participating business healthcare cooperative.

Features include:

Cooperative creation.
Participating business enrollment.
Eligibility requirements.
Membership rules.
Participation agreements.
Coverage periods.
Contribution rules.
Benefit selection.
Governance requirements.
Cooperative policies.
Legal structure documentation.
Jurisdiction tracking.
Membership changes.
Cooperative termination procedures.

Healthcare Fund Module

The Healthcare Fund Module manages the shared healthcare funding pool.

Features include:

Fund establishment.
Fund balances.
Business contributions.
Healthcare expenditures.
Administrative expenditures.
Reserve allocations.
Catastrophic allocations.
Investment allocations.
Cash flow forecasting.
Financial reconciliation.
Fund reporting.
Transaction histories.
Budget management.
Funding requirements.

Healthcare funds shall remain distinguishable from operating funds, reserves, and other cooperative assets when required by the governing structure.

Contribution Module

The Contribution Module calculates and manages the amounts participating businesses are expected to contribute.

Features include:

Business contribution schedules.
Employee enrollment counts.
Dependent enrollment.
Coverage selections.
Expected healthcare utilization.
Projected claims.
Administrative costs.
Reserve requirements.
Catastrophic exposure.
Geographic cost differences.
Historical experience.
Annual contribution recalculation.
Scenario modeling.
Contribution reconciliation.

The system shall clearly distinguish projected contributions from actual healthcare expenses.

Basic Coverage Module

The Basic Coverage Module establishes the minimum healthcare coverage included in the base cooperative contribution.

Every eligible cooperative participant shall receive, at minimum:

Three physician or qualified healthcare provider visits per coverage year.
Two urgent care visits per coverage year.

These visits shall be included in the base coverage cost rather than treated as optional add-on benefits.

The module shall track:

Eligibility.
Available visits.
Used visits.
Remaining visits.
Provider costs.
Geographic cost differences.
Utilization.
Actual paid amounts.
Projected annual cost.

Unused visits shall not automatically become cash credits or profit. Unused capacity remains part of the pooled healthcare funding model.

Benefits and Coverage Module

The Benefits and Coverage Module allows participating businesses to select additional healthcare benefits.

Potential benefits include:

Primary care.
Specialist care.
Hospitalization.
Emergency care.
Surgery.
Diagnostic testing.
Bloodwork.
Laboratory services.
Imaging.
Prescription medications.
Preventive care.
Mental healthcare.
Maternity care.
Cancer treatment.
Chronic disease management.
Rehabilitation.
Home healthcare.
Skilled nursing.
Dental care.
Vision care.
Hearing care.
Durable medical equipment.
Telehealth.
Other legally permitted healthcare benefits.

The system shall calculate the estimated incremental cost of selected benefits and incorporate those costs into the participating business’s funding requirements.

Member Medical Expense Submission and Reimbursement Module

The Member Medical Expense Submission and Reimbursement Module allows eligible participants to submit healthcare expenses for payment or reimbursement.

Supported submissions should include:

Medical bills.
Provider invoices.
Receipts.
Statements.
Supporting documentation.
Electronic submissions.
Mobile submissions.
Alternative submission methods.

The module shall provide:

Expense submission.
Document upload.
Expense categorization.
Coverage matching.
Supporting document tracking.
Submission status.
Payment status.
Reimbursement status.
Expense history.
Search and filtering.
Missing-document notifications.
Duplicate detection.
Appeals.
Human review.

Where a participating business has elected to cover a legitimate medical expense, the system should make submission and payment or reimbursement as simple as reasonably possible.

Claims Administration Module

The Claims Administration Module manages healthcare expense evaluation and payment.

Features include:

Claim intake.
Eligibility verification.
Benefit verification.
Coverage determination.
Documentation review.
Provider verification.
Payment authorization.
Direct provider payment.
Member reimbursement.
Partial reimbursement.
Coordination with other payers.
Claim reconciliation.
Claim status tracking.
Payment confirmation.
Appeals.
Human review.
Audit records.

The system shall provide an understandable explanation for significant claim decisions.

AI Medical Expense Processing Module

The AI Medical Expense Processing Module assists with processing submitted medical expenses.

AI capabilities may include:

Document recognition.
Data extraction.
Provider identification.
Service identification.
Procedure identification.
Date extraction.
Billed amount extraction.
Paid amount extraction.
Member responsibility extraction.
Other payer identification.
Benefit classification.
Duplicate detection.
Coding anomaly detection.
Unusual charge detection.
Coverage matching.
Cost comparison.
Fraud, waste, and abuse indicators.
Confidence scoring.

AI recommendations shall be explainable and auditable.

Healthcare Cost Intelligence Module

The Healthcare Cost Intelligence Module maintains current information about healthcare costs.

The system should analyze:

Average costs.
Median costs.
Regional costs.
Provider costs.
Primary care costs.
Specialist costs.
Urgent care costs.
Emergency care costs.
Hospital costs.
Procedure costs.
Laboratory costs.
Bloodwork costs.
Imaging costs.
Prescription costs.
Treatment costs.
Follow-up costs.
Rehabilitation costs.

The system shall distinguish between:

List prices.
Negotiated prices.
Allowed amounts.
Actual paid amounts.

Historical and current cost information shall be maintained so the cooperative can identify trends and changes.

Treatment Pathway Modeling Module

The Treatment Pathway Modeling Module estimates the complete cost of healthcare episodes rather than evaluating individual services in isolation.

Treatment pathways may include:

Initial symptoms.
Primary care.
Diagnostic testing.
Laboratory testing.
Imaging.
Specialist referral.
Additional testing.
Treatment.
Prescription medication.
Follow-up care.
Rehabilitation.
Chronic management.
Recurrence.
Complications.

The system should model alternative treatment pathways where appropriate and estimate:

Total episode cost.
Expected duration.
Expected utilization.
Expected frequency.
Provider requirements.
Follow-up requirements.
Potential complications.
Population-level financial exposure.

Annual Cost Recalculation Module

The Annual Cost Recalculation Module shall perform a comprehensive healthcare funding review at least once every twelve months.

The annual review shall evaluate:

Benefit costs.
Utilization.
Actual claims.
Provider costs.
Negotiated prices.
Treatment pathways.
Prescription costs.
Catastrophic expenses.
Reserve requirements.
Administrative costs.
Enrollment.
Inflation.
New treatments.
Obsolete treatments.
Healthcare utilization trends.
Geographic differences.
Contribution requirements.
Coverage expansion opportunities.

The system shall continuously collect cost and utilization information during the year while performing a formal comprehensive recalculation annually.

As historical cooperative data increases, actual experience should progressively replace assumptions in forecasting models.

Provider Network and Purchasing Module

The Provider Network and Purchasing Module supports cooperative purchasing and provider relationships.

Features include:

Provider discovery.
Provider credentialing.
Provider quality comparison.
Provider cost comparison.
Rate negotiation.
Provider contracts.
Bundled pricing.
Episode-based pricing.
Reference pricing.
Transparent pricing.
Volume purchasing.
Provider performance monitoring.
Member provider search.
Availability information.

The system should encourage competition among providers where legally and operationally appropriate.

Direct Healthcare Purchasing Module

The Direct Healthcare Purchasing Module enables the cooperative to evaluate direct purchasing opportunities.

Potential purchasing areas include:

Physicians.
Clinics.
Hospitals.
Laboratories.
Imaging providers.
Pharmacies.
Medical equipment providers.
Specialty care.
Diagnostic services.

The module should compare direct purchasing against traditional purchasing arrangements and identify opportunities for lower total cost without compromising quality.

Prescription Management Module

The Prescription Management Module manages prescription cost intelligence and purchasing opportunities.

Features include:

Prescription cost comparison.
Generic alternatives.
Therapeutic alternatives.
Pharmacy comparison.
Mail-order options.
Manufacturer assistance programs.
Cooperative purchasing.
Adherence monitoring.
Utilization forecasting.
High-cost medication monitoring.
Prescription trend analysis.

Clinical appropriateness shall remain subject to qualified healthcare professionals and applicable law.

Preventive Care Module

The Preventive Care Module supports preventive healthcare and early intervention.

Features include:

Preventive visits.
Health screenings.
Vaccinations.
Preventive testing.
Early detection.
Wellness programs.
Chronic disease prevention.
Utilization tracking.
Cost modeling.
Population health trends.

The system should evaluate preventive programs based on both healthcare outcomes and total cost impact.

Care Navigation Module

The Care Navigation Module helps participants identify appropriate healthcare resources.

Features include:

Provider discovery.
Specialist discovery.
Facility discovery.
Cost comparison.
Quality comparison.
Appointment assistance.
Referral coordination.
Second opinion support.
Treatment pathway information.
Care coordination.
Healthcare resource navigation.

The module should provide information and navigation assistance without replacing qualified medical professionals.

Quality and Outcomes Module

The Quality and Outcomes Module evaluates healthcare value by considering both cost and outcomes.

Features include:

Provider quality.
Treatment outcomes.
Complications.
Readmissions.
Preventive outcomes.
Treatment effectiveness.
Member experience.
Cost-to-outcome analysis.
Provider performance trends.

The system should avoid treating the lowest price as automatically representing the best healthcare value.

Fraud, Waste, and Abuse Module

The Fraud, Waste, and Abuse Module identifies suspicious or inefficient healthcare spending.

Features include:

Duplicate claims.
Duplicate payments.
Unusual billing.
Excessive charges.
Unusual utilization.
Provider patterns.
Member patterns.
Billing inconsistencies.
Coding anomalies.
Administrative waste.
Risk scoring.
Investigation workflows.
Recovery tracking.
Reporting.

AI-generated risk indicators shall trigger appropriate review rather than automatically establish wrongdoing.

Investment and Treasury Module

The Investment and Treasury Module manages cooperative funds that are not immediately required for healthcare payments or operating expenses.

The primary objectives shall be:

Capital preservation.
Liquidity.
Reliable access to healthcare funds.
Appropriate maturity management.
Protection of reserves.

The cooperative should maintain a written Treasury Investment Policy.

Funds not immediately required may be allocated to conservative instruments such as short-duration U.S. Treasury obligations, including Treasury bills, subject to the cooperative’s legal and financial requirements.

Treasury holdings should be structured around projected cash requirements and may use maturity ladders for longer-term reserves.

The system should avoid speculative investments, leverage, derivatives, cryptocurrency, commodities speculation, concentrated equity exposure, and investments selected primarily for yield.

The module shall support:

Cash forecasting.
Treasury maturity tracking.
Liquidity monitoring.
Reserve allocation.
Custodian evaluation.
Counterparty evaluation.
Fee monitoring.
Investment reporting.
Investment reconciliation.
Policy tracking.
Audit trails.

AI may monitor markets, yields, maturities, projected claims, liquidity, and reserve requirements and may make recommendations. AI shall not independently authorize investments or transfer cooperative funds.

Reserve and Catastrophic Risk Module

The Reserve and Catastrophic Risk Module maintains financial protection against unexpected healthcare expenses.

Reserve categories may include:

Operating reserves.
Claims reserves.
Emergency reserves.
Catastrophic reserves.
Long-term healthcare reserves.

The module shall support:

Reserve calculations.
High-cost claimant modeling.
Population risk modeling.
Stress testing.
Claims volatility analysis.
Catastrophic exposure analysis.
Stop-loss analysis.
Reinsurance analysis.
Reserve adequacy monitoring.

Any stop-loss or reinsurance arrangement shall be evaluated according to applicable law and the cooperative’s legal structure.

Financial Modeling Module

The Financial Modeling Module forecasts the cooperative’s financial requirements.

Features include:

Per-member-per-month calculations.
Business contribution calculations.
Expected claims.
Administrative expenses.
Reserve requirements.
Catastrophic exposure.
Investment income.
Enrollment scenarios.
Utilization scenarios.
Inflation scenarios.
Multi-year forecasts.
Coverage expansion scenarios.
Cost reduction scenarios.
Stress testing.

Cost Transparency Module

The Cost Transparency Module provides understandable information about how cooperative funds are used.

Reports should address:

Contributions.
Healthcare spending.
Claims.
Reimbursements.
Provider spending.
Administrative costs.
Reserves.
Investments.
Investment income.
Cost trends.
Coverage costs.

Members and participating businesses should be able to understand the major factors affecting healthcare costs.

Member Portal Module

The Member Portal Module provides participants with access to healthcare funding information and services.

Features include:

Coverage dashboards.
Benefit information.
Expense submission.
Reimbursement requests.
Claim status.
Expense history.
Provider search.
Cost comparison.
Treatment estimates.
Care navigation.
Notifications.
Documents.
Statements.
Appeals.

Business Administration Module

The Business Administration Module manages participating employer operations.

Features include:

Business onboarding.
Employee enrollment.
Dependent enrollment.
Eligibility management.
Benefit selection.
Contribution management.
Payroll integration.
Employee roster management.
Enrollment changes.
Terminations.
Renewals.
Benefit reviews.
Financial reconciliation.
Business reporting.

Governance Module

The Governance Module supports accountable cooperative management.

Features include:

Cooperative governance.
Business representation.
Member representation.
Voting.
Board management.
Policy approval.
Benefit oversight.
Investment oversight.
Conflict-of-interest management.
Fiduciary controls.
Financial oversight.
Audits.
Transparency requirements.

Independent Oversight Module

The Independent Oversight Module provides mechanisms for reviewing important cooperative decisions.

Oversight may include:

Financial review.
Claims review.
Investment review.
AI decision review.
Benefit review.
Regulatory review.
Vendor review.
Conflict review.
Audit review.

Regulatory Classification and Compliance Module

The Regulatory Classification and Compliance Module evaluates the legal and regulatory requirements applicable to the cooperative.

The module shall evaluate, as applicable:

State insurance requirements.
Federal healthcare requirements.
Self-funded plan requirements.
ERISA considerations.
MEWA considerations.
ACA requirements.
Tax requirements.
Privacy requirements.
Healthcare data requirements.
Licensing.
Reporting.
Filing obligations.
Fiduciary requirements.
Regulatory changes.

The system shall identify areas requiring qualified legal review.

AI shall assist with regulatory research and monitoring but shall not represent its analysis as legal advice or replace qualified legal counsel.

Privacy and Data Governance Module

The Privacy and Data Governance Module protects healthcare and financial information.

Features include:

Access controls.
Role-based permissions.
Least-privilege access.
Encryption.
Secure storage.
Data minimization.
Retention policies.
Deletion policies.
Audit logging.
Privacy controls.
Member data controls.
Business data controls.
Administrative controls.
Incident response.
Breach response.

Human Oversight Module

The Human Oversight Module ensures that consequential automated recommendations remain subject to human review.

Features include:

Review queues.
Approval workflows.
AI confidence scores.
Explainable recommendations.
Human overrides.
Decision documentation.
Escalation.
Appeals.
Audit trails.

Vendor Independence Module

The Vendor Independence Module prevents unnecessary dependence on a single healthcare, financial, technology, or service provider.

Features include:

Vendor-neutral interfaces.
Multiple provider options.
Multiple custodians where appropriate.
Contract transparency.
Data portability.
Vendor replacement procedures.
Open interfaces.
Export capabilities.
Lock-in monitoring.

Interoperability Module

The Interoperability Module supports exchange of information among healthcare, financial, administrative, and cooperative systems.

Supported information may include:

Eligibility data.
Healthcare records.
Claims.
Provider information.
Payments.
Reimbursements.
Financial records.
Documents.
Contribution data.
Benefit information.

The system should support standardized and portable data exchange wherever practical.

Analytics and Reporting Module

The Analytics and Reporting Module provides operational and strategic reporting.

Dashboards and reports may cover:

Healthcare spending.
Claims.
Reimbursements.
Utilization.
Providers.
Benefits.
Investments.
Reserves.
Contributions.
Businesses.
Members.
Population trends.
Outcomes.
Cost trends.
Annual assessments.
Regulatory reporting.
Audits.

Member Rights Module

The Member Rights Module defines participant rights within the cooperative.

Members should be able to:

Understand their coverage.
Access relevant records.
Understand healthcare funding decisions.
Understand reimbursement decisions.
Request human review.
Appeal eligible decisions.
Understand contributions.
Understand major healthcare costs.
Understand applicable policies.
Exercise applicable privacy rights.

Economic Efficiency Module

The Economic Efficiency Module identifies structural opportunities to reduce healthcare costs.

Features include:

Administrative cost analysis.
Intermediary analysis.
Provider competition.
Collective purchasing.
Direct purchasing.
Transparent pricing.
Billing accuracy.
Waste reduction.
Preventive care analysis.
Early intervention.
Treatment pathway optimization.
Negotiated pricing.
Bundled pricing.
Data-driven purchasing.

Emergency Continuity Module

The Emergency Continuity Module maintains healthcare funding operations during disruptions.

Features include:

Emergency claims processing.
Emergency payments.
Provider access.
Emergency reserve management.
Disaster continuity.
System redundancy.
Critical vendor redundancy.
Recovery procedures.
Emergency governance.
Business continuity planning.

Auditability Module

The Auditability Module maintains a complete record of significant cooperative activity.

Audit records should cover:

Contributions.
Claims.
Reimbursements.
Provider payments.
Investments.
Fund transfers.
Reserves.
Administrative expenses.
AI recommendations.
Human decisions.
Coverage decisions.
Policy versions.
Regulatory decisions.
Governance decisions.

Open Cooperative Marketplace Module

The Open Cooperative Marketplace Module enables participating businesses to collaborate on healthcare purchasing opportunities.

Features include:

Shared purchasing opportunities.
Provider purchasing.
Group contracts.
Volume discounts.
Shared healthcare programs.
Regional purchasing.
National purchasing.
Business-to-provider opportunities.

Continuous Improvement Module

The Continuous Improvement Module evaluates the cooperative’s performance and identifies opportunities for improvement.

The system should continuously evaluate:

Healthcare costs.
Utilization.
Provider pricing.
Claims.
Reimbursements.
Treatment trends.
Emerging healthcare technologies.
New treatments.
Purchasing opportunities.
Member experience.
Provider performance.
Financial performance.

A formal strategic review should occur at least annually.

Optional Plugin Modules

United Care Fund shall support optional plugin modules that can extend the core system without requiring every cooperative to implement every capability.

Telehealth Plugin

Provides telehealth provider access, virtual appointments, cost analysis, utilization tracking, and integration with eligible benefits.

Dental Plugin

Adds dental benefits, provider purchasing, preventive dental care, claims processing, cost intelligence, and reimbursement.

Vision Plugin

Adds vision benefits, provider networks, examinations, corrective products, claims processing, and reimbursement.

Hearing Plugin

Adds hearing-related benefits, provider purchasing, devices, diagnostics, and reimbursement.

Mental Healthcare Plugin

Adds expanded mental healthcare benefits, provider navigation, treatment pathways, cost intelligence, and utilization analysis.

Chronic Care Plugin

Supports chronic disease management, care coordination, preventive intervention, treatment tracking, and long-term cost modeling.

Maternity Plugin

Supports maternity-related benefits, prenatal care, delivery costs, postpartum care, treatment pathways, provider comparisons, and cost forecasting.

Cancer Care Plugin

Supports cancer treatment pathways, provider comparisons, treatment cost modeling, prescription analysis, and care navigation.

International Care Plugin

Supports eligible international healthcare arrangements, cross-border provider research, cost comparison, travel considerations, and applicable regulatory review.

Healthcare Savings Plugin

Provides additional healthcare savings programs, discounts, cooperative purchasing opportunities, and member cost reduction programs.

Advanced Actuarial Plugin

Provides advanced actuarial modeling, population risk analysis, scenario modeling, reserve analysis, and external actuarial review workflows.

Advanced Provider Negotiation Plugin

Provides advanced provider pricing analysis, contract comparison, negotiation support, bundled pricing analysis, and purchasing strategy.

Advanced Fraud Analysis Plugin

Provides enhanced anomaly detection, network analysis, behavioral analysis, risk scoring, and investigation support.

Employer Benefits Marketplace Plugin

Allows participating businesses to compare and select additional benefit programs from approved providers.

Pharmacy Purchasing Plugin

Provides advanced cooperative prescription purchasing, pharmacy contract analysis, bulk purchasing, specialty medication analysis, and prescription cost forecasting.

Investment Analytics Plugin

Provides enhanced Treasury analysis, maturity optimization, liquidity forecasting, reserve modeling, custodian analysis, and investment policy monitoring while maintaining human authorization requirements.

AI Requirements

AI shall function as an analytical and decision-support component of United Care Fund.

AI capabilities should include:

Healthcare cost research.
Cost estimation.
Treatment pathway modeling.
Utilization forecasting.
Financial forecasting.
Provider analysis.
Claims analysis.
Medical expense extraction.
Anomaly detection.
Fraud, waste, and abuse indicators.
Regulatory monitoring.
Scenario analysis.
Annual cost recalculation.
Recommendation generation.

AI systems shall:

Provide explanations for significant recommendations.
Identify uncertainty.
Provide confidence information where appropriate.
Preserve audit records.
Identify source data used for material calculations.
Allow human review.
Avoid presenting estimates as guarantees.
Avoid replacing medical professionals.
Avoid replacing legal professionals.
Avoid independently controlling cooperative funds.

Data and Cost Intelligence Requirements

Healthcare cost estimates shall use the best available real-world information.

The system should prefer actual cooperative experience as historical data becomes available.

Cost models should consider:

Geography.
Provider type.
Provider pricing.
Service type.
Procedure.
Treatment pathway.
Utilization.
Population characteristics.
Inflation.
Prescription costs.
Healthcare trends.
Historical claims.
Actual paid amounts.

The system shall clearly distinguish estimates from actual expenses.

Annual Funding Review

At least once every twelve months, the cooperative shall conduct a comprehensive funding review.

The review shall produce recommendations concerning:

Base coverage costs.
Additional benefit costs.
Business contributions.
Claims expectations.
Reserve requirements.
Catastrophic exposure.
Administrative costs.
Provider purchasing.
Prescription purchasing.
Investment and treasury management.
Cost reduction opportunities.
Coverage expansion opportunities.

The annual review should identify both potential savings and potential improvements in healthcare coverage.

Security and Privacy

United Care Fund shall treat healthcare and financial information as sensitive information requiring appropriate protection.

Security controls shall include:

Authentication.
Authorization.
Access control.
Encryption.
Secure data storage.
Audit logging.
Data minimization.
Retention management.
Incident response.
Backup and recovery.
Administrative oversight.

The system shall comply with applicable privacy and healthcare information requirements based on the cooperative’s legal structure and jurisdiction.

Transparency

The cooperative shall provide meaningful transparency regarding how funds are collected and used.

Participating businesses and eligible members should be able to understand:

How contributions are calculated.
What benefits are covered.
How healthcare costs are estimated.
How claims are processed.
How reimbursements are calculated.
How providers are selected.
How reserves are maintained.
How cooperative funds are managed.
What administrative expenses exist.
How healthcare costs change over time.

Implementation

United Care Fund is a specification rather than a requirement to implement every module.

Implementations should begin with the core capabilities required for the cooperative’s intended purpose and jurisdiction.

Modules should remain independently maintainable and replaceable where practical.

Implementations should support future expansion without requiring the redesign of the entire cooperative.

Legal and Regulatory Disclaimer

United Care Fund is a technical and organizational specification and does not establish a particular legal structure.

A real-world implementation may be subject to healthcare, insurance, employee benefit, tax, privacy, securities, fiduciary, employment, and other laws and regulations.

Each implementation shall obtain appropriate professional legal, regulatory, actuarial, accounting, and healthcare guidance before accepting contributions, providing benefits, entering provider arrangements, processing healthcare claims, or investing cooperative funds.

Specification Branding License (SBL)

Standard

Fully AGPL-3.0+ compliant system.
Copyleft enforced for network deployments.
Required attribution:
Roxanne Ardary.
roxanneardary.com.

Optional

Specification Branding License (SBL)
Attribution-free commercial deployment.
Pricing based on scale, usage, and deployment scope.
United Care Fund.

License & Notice Requirements

United Care Fund is released under the GNU Affero General Public License v3.0 or later (AGPL-3.0+).

By contributing to any Open Arsenal project, you agree that your contributions will also be released under this license.

Please note the following:

All contributions must comply with the AGPL-3.0+ terms.
Under Section 7 of the license, all redistributions, forks, and derivative works must preserve attribution to Roxanne Ardary and roxanneardary.com.
United Care Fund specifications are free to use with attribution. A Specification Branding License can be negotiated upon request.
The project’s notice.md file tracks attribution requirements and contributor acknowledgments. Any update that adds new contributors or modifies attribution should also update notice.md.
When submitting a pull request, ensure that any new files maintain the attribution headers where applicable.
Network-deployed versions of this software must also remain fully AGPL-3.0+ compliant, including exposure of source code modifications when applicable under the license.

For full legal details, please refer to the AGPL-3.0+ license and the project’s notice.md file.

Notice – United Care Fund

Attribution Requirement: Under Section 7 of the AGPL 3.0+ license, all redistributions, forks, and derivative works, including network-deployed versions of this project, must provide attribution to Roxanne Ardary and roxanneardary.com.

Contributors

This file tracks contributors and their specific contributions to the project.

Roxanne Ardary, roxanneardary.com – September 6, 2026
Created the repository for United Care Fund. Developed the specification for a cooperative healthcare funding framework that enables participating businesses to work together to reduce healthcare costs and provide better, more affordable coverage.
[Add other contributors here] – [Date]
[Describe contribution in one sentence]

License – United Care Fund

This repository is licensed under the GNU Affero General Public License v3.0 or later (AGPL-3.0+).

Key Points:

You are free to use, modify, and distribute the code.
All redistributions, forks, and derivative works or network-deployed versions must also be licensed under AGPL-3.0+ and provide attribution to Roxanne Ardary and roxanneardary.com as required under Section 7 of the license.
The software is provided “as is,” without warranty of any kind.

For the full license text, see GNU AGPL-3.0 License.