EX-10.12






Exhibit 10.12




Medicare Advantage Attestation of Benefit Plan




WELLCARE HEALTH INSURANCE OF ILLINOIS, INC.




H4577




Date: 09/02/2008



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	 	Effective
	ID	 	ID	 	Version	 	Plan Name	 	Type	 	Type	 	Premium	 	Premium	 	Approval Date	 	Date
	003	 	0	 	5	 	Melody
	 	PFFS	 	Renewal	 	0.00	 	N/A	 	09/02/2008	 	01/01/2009
	012	 	0	 	6	 	Concert
	 	PFFS	 	Renewal	 	0.00	 	0.00	 	09/02/2008	 	01/01/2009
	016	 	0	 	5	 	Prelude
	 	PFFS	 	Renewal	 	0.00	 	N/A	 	09/02/2008	 	01/01/2009
	020	 	0	 	6	 	Sonata
	 	PFFS	 	Renewal	 	0.00	 	N/A	 	09/02/2008	 	01/01/2009
	021	 	0	 	5	 	Sonata
	 	PFFS	 	Renewal	 	0.00	 	N/A	 	09/02/2008	 	01/01/2009
	022	 	0	 	6	 	Sonata
	 	PFFS	 	Renewal	 	0.00	 	N/A	 	09/02/2008	 	01/01/2009
	023	 	0	 	6	 	Sonata
	 	PFFS	 	Renewal	 	49.00	 	N/A	 	09/02/2008	 	01/01/2009
	026	 	0	 	5	 	Melody
	 	PFFS	 	Renewal	 	55.00	 	N/A	 	09/02/2008	 	01/01/2009
	027	 	0	 	5	 	Melody
	 	PFFS	 	Renewal	 	69.00	 	N/A	 	09/02/2008	 	01/01/2009
	029	 	0	 	7	 	Concert
	 	PFFS	 	Renewal	 	0.00	 	0.00	 	09/02/2008	 	01/01/2009
	030	 	0	 	7	 	Concert
	 	PFFS	 	Renewal	 	19.20	 	9.80	 	09/02/2008	 	01/01/2009
	031	 	0	 	7	 	Concert
	 	PFFS	 	Renewal	 	43.80	 	21.20	 	09/02/2008	 	01/01/2009
	032	 	0	 	7	 	Concert
	 	PFFS	 	Renewal	 	69.50	 	19.50	 	09/02/2008	 	01/01/2009





 Page 1 of 3  — WELLCARE HEALTH INSURANCE OF ILLINOIS, INC. — H4577 — 09/02/2008



 









 






	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 	 
	Plan	 	Segment	 	 	 	 	 	Plan	 	Transaction	 	MA	 	Part D	 	CMS	 	Effective
	ID	 	ID	 	Version	 	Plan Name	 	Type	 	Type	 	Premium	 	Premium	 	Approval Date	 	Date
	033	 	0	 	5	 	Serenade
	 	PFFS	 	Renewal	 	39.00	 	N/A	 	09/02/2008	 	01/01/2009
	034	 	0	 	5	 	Serenade
	 	PFFS	 	Renewal	 	59.00	 	N/A	 	09/02/2008	 	01/01/2009
	035	 	0	 	6	 	Serenade
	 	PFFS	 	Renewal	 	79.00	 	N/A	 	09/02/2008	 	01/01/2009
	036	 	0	 	6	 	Serenade
	 	PFFS	 	Renewal	 	129.00	 	N/A	 	09/02/2008	 	01/01/2009
	037	 	0	 	5	 	Quartet
	 	PFFS	 	Renewal	 	96.00	 	N/A	 	09/02/2008	 	01/01/2009
	038	 	0	 	5	 	Sonata Plus
	 	PFFS	 	Renewal	 	0.00	 	N/A	 	09/02/2008	 	01/01/2009
	039	 	0	 	5	 	Sonata Plus
	 	PFFS	 	Renewal	 	0.00	 	N/A	 	09/02/2008	 	01/01/2009
	040	 	0	 	5	 	Sonata Plus
	 	PFFS	 	Renewal	 	0.00	 	N/A	 	09/02/2008	 	01/01/2009
	041	 	0	 	5	 	Sonata Plus
	 	PFFS	 	Renewal	 	0.00	 	N/A	 	09/02/2008	 	01/01/2009'
	042	 	0	 	5	 	Sonata Plus
	 	PFFS	 	Renewal	 	0.00	 	N/A	 	09/02/2008	 	01/01/2009
	043	 	0	 	5	 	Sonata Plus
	 	PFFS	 	Renewal	 	0.00	 	N/A	 	09/02/2008	 	01/01/2009
	044	 	0	 	5	 	Melody Plus
	 	PFFS	 	Renewal	 	0.00	 	N/A	 	09/02/2008	 	01/01/2009
	045	 	0	 	6	 	Melody Plus
	 	PFFS	 	Renewal	 	0.00	 	N/A	 	09/02/2008	 	01/01/2009
	046	 	0	 	5	 	Melody Plus
	 	PFFS	 	Renewal	 	0.00	 	N/A	 	09/02/2008	 	01/01/2009
	047	 	0	 	5	 	Melody Plus
	 	PFFS	 	Renewal	 	0.00	 	N/A	 	09/02/2008	 	01/01/2009
	048	 	0	 	5	 	Melody Plus
	 	PFFS	 	Renewal	 	0.00	 	N/A	 	09/02/2008	 	01/01/2009
	049	 	0	 	5	 	Melody Plus
	 	PFFS	 	Renewal	 	0.00	 	N/A	 	09/02/2008	 	01/01/2009
	801	 	0	 	3	 	Employer Plan 3
	 	PFFS	 	Renewal	 	0.00'	 	N/A	 	08/29/2008	 	01/01/2009
	802	 	0	 	3	 	Employer Plan 4
	 	PFFS	 	Renewal	 	0.00	 	N/A	 	08/29/2008	 	01/01/2009
	803	 	0	 	3	 	Employer Plan 9
	 	PFFS	 	Renewal	 	0.00	 	N/A	 	08/29/2008	 	01/01/2009
	804	 	0	 	3	 	Employer Plan 10
	 	PFFS	 	Renewal	 	0.00	 	N/A	 	08/29/2008	 	01/01/2009






Page 2 of 3  — WELLCARE HEALTH INSURANCE OF ILLINOIS, INC. — H4577 — 09/02/2008




 









 








	 	 	 
	/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 — WELLCARE HEALTH INSURANCE OF ILLINOIS, INC. — H4577 — 09/02/2008