EX-10.3






Exhibit 10.3




Medicare Advantage Attestation of Benefit Plan




HARMONY HEALTH PLAN OF ILLINOIS, INC.




H1416




Date: 08/29/2008



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 above-stated organization will make available
to eligible beneficiaries in the approved service area during program year 2009. 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 attest that I have examined the employer/union-only group waiver (“800 series”) PBPs identified
below and that these PBPs are those that the above-stated organization will make available only to
eligible employer/union-sponsored group plan beneficiaries in the approved service area during
program year 2009. I further attest we have reviewed any MA bid pricing tools (BPTs) associated
with these PBPs (no Part D bids are required for 2009 “800 series” PBPs) with the certifying
actuary and have determined them to be consistent with any MA 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 2008 and 2009, including but not limited to, the 2009 Call
Letter, the 2009 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	 	Segment	 	 	 	 	 	 	 	 	 	Plan	 	Transaction	 	MA	 	Part D	 	CMS Approval	 	Effective
	ID	 	ID	 	Version	 	Plan Name	 	Type	 	Type	 	Premium	 	Premium	 	Date	 	Date
	002
	 	 	0	 	 	 	6	 	 	WellCare Choice	 	HMOPOS	 	Renewal	 	 	0.00	 	 	 	0.00	 	 	 	08/29/2008	 	 	 	01/01/2009	 
	003
	 	 	0	 	 	 	6	 	 	WellCare Select	 	HMOPOS	 	Renewal	 	 	0.00	 	 	 	7.50	 	 	 	08/29/2008	 	 	 	01/01/2009	 
	007
	 	 	0	 	 	 	6	 	 	WellCare Access	 	HMO	 	Renewal	 	 	0.00	 	 	 	7.80	 	 	 	08/29/2008	 	 	 	01/01/2009	 
	009
	 	 	0	 	 	 	6	 	 	WellCare Value	 	HMOPOS	 	Renewal	 	 	0.00	 	 	 	0.00	 	 	 	08/29/2008	 	 	 	01/01/2009	 
	013
	 	 	0	 	 	 	6	 	 	WellCare Select	 	HMOPOS	 	Renewal	 	 	0.00	 	 	 	7.40	 	 	 	08/29/2008	 	 	 	01/01/2009	 
	014
	 	 	0	 	 	 	6	 	 	WellCare Value	 	HMOPOS	 	Renewal	 	 	0.00	 	 	 	0.00	 	 	 	08/29/2008	 	 	 	01/01/2009	 
	017
	 	 	0	 	 	 	7	 	 	WellCare Select	 	HMOPOS	 	Renewal	 	 	0.00	 	 	 	11.00	 	 	 	08/29/2008	 	 	 	01/01/2009	 
	018
	 	 	0	 	 	 	6	 	 	WellCare Value	 	HMOPOS	 	Renewal	 	 	0.00	 	 	 	0.00	 	 	 	08/29/2008	 	 	 	01/01/2009	 
	019
	 	 	0	 	 	 	7	 	 	WellCare Rx	 	HMOPOS	 	Renewal	 	 	0.00	 	 	 	24.10	 	 	 	08/29/2008	 	 	 	01/01/2009	 
	020
	 	 	0	 	 	 	7	 	 	WellCare Rx	 	HMOPOS	 	Renewal	 	 	0.00	 	 	 	25.20	 	 	 	08/29/2008	 	 	 	01/01/2009	 
	021
	 	 	0	 	 	 	6	 	 	WellCare Rx	 	HMOPOS	 	Renewal	 	 	0.00	 	 	 	31.60	 	 	 	08/29/2008	 	 	 	01/01/2009	 
	801
	 	 	0	 	 	 	4	 	 	Employer Illinois 1	 	HMOPOS	 	Renewal	 	 	0.00	 	 	 	N/A	 	 	 	08/29/2008	 	 	 	01/01/2009	 
	802
	 	 	0	 	 	 	4	 	 	Employer Illinois 2	 	HMOPOS	 	Renewal	 	 	0.00	 	 	 	N/A	 	 	 	08/29/2008	 	 	 	01/01/2009	 





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	Plan	 	Segment	 	 	 	 	 	 	 	 	 	Plan	 	Transaction	 	MA	 	Part D	 	CMS Approval	 	Effective
	ID	 	ID	 	Version	 	Plan Name	 	Type	 	Type	 	Premium	 	Premium	 	Date	 	Date
	803
	 	 	0	 	 	 	4	 	 	Employer Illinois 3	 	HMOPOS	 	Renewal	 	 	0.00	 	 	 	N/A	 	 	 	08/29/2008	 	 	 	01/01/2009	 
	804
	 	 	0	 	 	 	4	 	 	Employer Illinois 4	 	HMOPOS	 	Renewal	 	 	0.00	 	 	 	N/A	 	 	 	08/29/2008	 	 	 	01/01/2009	 






Page 2 of 3  — HARMONY HEALTH PLAN OF ILLINOI, INC. — H1416 — 08/29/2008




 









 








	 	 	 	 	 
	 
	 	 	 	 
	/s/ Heath Schiesser
 

CEO:

	 	9/5/08
 

Date:
	 	 
	Heath Schiesser
	 	 	 	 
	CEO/President
	 	 	 	 
	8735 Henderson Road
	 	 	 	 
	Tampa, FL 33634
	 	 	 	 
	813-290-6205
	 	 	 	 
	 
	 	 	 	 
	/s/ Thomas L. Tran
 

CFO:

	 	9/5/08
 

Date:
	 	 
	Tom Tran
	 	 	 	 
	CFO
	 	 	 	 
	8735 Henderson Road
	 	 	 	 
	Tampa, FL 33634
	 	 	 	 
	813-290-6200 (1770)
	 	 	 	 






Page 3 of 3  — HARMONY HEALTH PLAN OF ILLINOI, INC. — H1416 — 08/29/2008