Back to Form 8-K [form8-k.htm]
Exhibit 10.6
Medicare Advantage Attestation of Benefit Plan
 
WELL CARE OF FLORIDA, INC.
 
H1032
 
Date: 08/29/2012
 
I attest that I have examined the Plan Benefit Packages (PBPs) identified below
and that the benefits identified in the PBPs are those that the above­stated
organization will make available to eligible beneficiaries in the approved
service area during program year 2013. I further attest that we have reviewed
the bid pricing tools (BPTs) with the certifying actuary and have determined
them to be consistent with the PBPs being attested to here.
 
I further attest that these benefits will be offered in accordance with all
applicable Medicare program authorizing statutes and regulations and program
guidance that CMS has issued to date and will issue during the remainder of 2012
and 2013, including but not limited to, the 2013 Call Letter, the 2013
Solicitations for New Contract Applicants, the Medicare Prescription Drug
Benefit Manual, the Medicare Managed Care Manual, and the CMS memoranda issued
through the Health Plan Management System (HPMS).
 
Plan
ID
Segment
ID
Version
Plan Name
Plan
Type
Transaction
Type
MA
Premium
Part D Premium
CMS Approval Date
Effective
Date
002
0
6
WellCare Choice (HMO- POS)
HMOPOS
Renewal
39.70
0.90
08/20/2012
01/01/2013
008
0
7
WellCare Choice (HMO)
HMO
Renewal
0.00
0.00
08/20/2012
01/01/2013
025
0
7
WellCare Choice (HMO- POS)
HMOPOS
Renewal
52.90
1.70
08/20/2012
01/01/2013
032
0
6
WellCare Dividend (HMO)
HMO
Renewal
0.00
0.00
08/20/2012
01/01/2013
035
0
6
WellCare Value (HMO- POS)
HMOPOS
Renewal
0.00
0.00
08/20/2012
01/01/2013
037
0
6
WellCare Advance (HMO)
HMO
Renewal
0.00
N/A
08/20/2012
01/01/2013
040
0
7
WellCare Dividend (HMO)
HMO
Renewal
0.00
0.00
08/20/2012
01/01/2013
061
0
6
WellCare Select (HMO- POS SNP)
HMOPOS
Renewal
0.00
8.50
08/20/2012
01/01/2013
073
0
7
WellCare Value (HMO- POS)
HMOPOS
Renewal
0.00
0.00
08/20/2012
01/01/2013
079
0
7
WellCare Value (HMO)
HMO
Renewal
0.00
0.00
08/20/2012
01/01/2013
091
0
6
WellCare Value (HMO- POS)
HMOPOS
Renewal
0.00
0.00
08/20/2012
01/01/2013
101
0
6
WellCare Select (HMO- POS SNP)
HMOPOS
Renewal
0.00
12.50
08/20/2012
01/01/2013
124
0
6
WellCare Liberty (HMO SNP) 
HMO
Renewal
0.00
8.70
08/20/2012
01/01/2013

H1032

 
 

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 Plan
ID
 Segment
ID
 Version  Plan Name  Plan
Type
 Transaction
Type
 MA
Premium
 Part D
Premium
 CMS Approval
Date
 Effective
Date
133
0
7
WellCare Essential (HMO)
HMO
Renewal
0.00
0.00
08/20/2012
01/01/2013
170
0
6
WellCare Liberty (HMO SNP)
HMO
Renewal
0.00
11.80
08/20/2012
01/01/2013
173
0
7
WellCare Essential (HMO)
HMO
Renewal
0.00
0.00
08/20/2012
01/01/2013
174
0
7
WellCare Essential (HMO)
HMO
Renewal
0.00
0.00
08/20/2012
01/01/2013
175
0
6
WellCare Access (HMO SNP)
HMO
Renewal
0.00
12.10
08/20/2012
01/01/2013
176
0
6
WellCare Access (HMO SNP)
HMO
Renewal
0.00
12.20
08/20/2012
01/01/2013
177
0
6
WellCare Value (HMO- POS)
HMOPOS
Renewal
0.00
0.00
08/20/2012
01/01/2013
179
0
8
WellCare Dividend (HMO)
HMO
Renewal
0.00
0.00
08/20/2012
01/01/2013

 
 
 

H1032

 
 

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 THOMAS TRAN    8/29/2012 2:01:31 PM             Contracting Official Name  
 Date                        8735 Henderson Rd        Ren 1    WELL CARE OF
FLORIDA, INC.    Tampa, FL 33634            Organization    Address  

 
 
 
H1032