h3361cmsrenewal.htm


    
      Back to Form 8-K

      Exhibit 10.26


      
        Medicare
Advantage Attestation of Benefit Plan

      

      
        WELLCARE_OF
NEW YORK, INC.

      

      
        H3361

      

      
        Date:
09/01/2009

        


        


      

      
        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 2010. 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 2009 and 2010,
including but not limited to, the 2010 Call Letter, the 2010 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

                

              
	
                
                  039

                

              	
                
                  0

                

              	
                
                  4

                

              	
                
                  WellCare
      Dividend 

                  (HMO)

                

              	
                
                  HMO

                

              	
                
                  Renewal

                

              	
                
                  0.00

                

              	
                
                  N/A

                

              	
                
                  08/27/2009

                

              	
                
                  01/01/2010

                

              
	
                
                  043

                

              	
                
                  0

                

              	
                
                  5

                

              	
                
                  WellCare
      Select (HMO-  POS)

                

              	
                
                  HMOPOS

                

              	
                
                  Renewal

                

              	
                
                  0.00

                

              	
                
                  31.60

                   

                

              	
                
                  08/31/2009

                

              	
                
                  01/01/2010

                

              
	
                
                  047

                

              	
                
                  0

                

              	
                
                  5

                

              	
                
                  WellCare
      Liberty (HMO)

                

              	
                
                  HMO

                

              	
                
                  Renewal

                

              	
                
                  0.00

                

              	
                
                  30.60

                

              	
                
                  08/31/2009

                

              	
                
                  01/01/2010

                

              
	
                
                  059

                

              	
                
                  0

                

              	
                
                  4

                

              	
                
                  WellCare
      Advance 

                  (HMO)

                

              	
                
                  HMO

                

              	
                
                  Renewal

                

              	
                
                  0.00

                

              	
                
                  N/A

                

              	
                
                  08/27/2009

                

              	
                
                  01/01/2010

                

              
	
                
                  065

                

              	
                
                  0

                

              	
                
                  5

                

              	
                
                  WellCare
      Access (HMO)

                

              	
                
                  HMO

                

              	
                
                  Renewal

                

              	
                
                  0.00

                

              	
                
                  33.30

                

              	
                
                  08/31/2009

                

              	
                
                  01/01/2010

                

              
	
                
                  098

                

              	
                
                  0

                

              	
                
                  5

                

              	
                
                  WellCare
      Select (HMO- POS)

                

              	
                
                  HMOPOS

                

              	
                
                  Renewal

                

              	
                
                  0.00

                

              	
                
                  29.40

                

              	
                
                  08/31/2009

                

              	
                
                  01/01/2010

                

              
	
                
                  099

                

              	
                
                  0

                

              	
                
                  5

                

              	
                
                  WellCare
      Value (HMO-

                  POS)

                

              	
                
                  HMOPOS

                

              	
                
                  Renewal

                

              	
                
                  0.00

                

              	
                
                  0.00

                

              	
                
                  08/31/2009

                

              	
                
                  01/01/2010

                

              
	
                
                  105

                

              	
                
                  0

                

              	
                
                  5

                

              	
                
                  WellCare
      Advocate Complete (HMO)

                

              	
                
                  HMO

                

              	
                
                  Renewal

                

              	
                
                  0.00

                

              	
                
                  29.50

                

              	
                
                  08/31/2009

                

              	
                
                  01/01/2010

                

              
	
                
                  106

                

              	
                
                  0

                

              	
                
                  5

                

              	
                
                  WellCare
      Choice (HMO-POS)

                

              	
                
                  HMOPOS

                

              	
                
                  Renewal

                

              	
                
                  0.00

                

              	
                
                  0.00

                

              	
                
                  08/31/2009

                

              	
                
                  01/01/2010

                

              
	
                
                  109

                

              	
                
                  0

                

              	
                
                  5

                

              	
                
                  WellCare
      Access (HMO)

                

              	
                
                  HMO

                

              	
                
                  Renewal

                

              	
                
                  0.00

                

              	
                
                  33.30

                

              	
                
                  08/31/2009

                

              	
                
                  01/01/2010

                

              


      

      
         

         

         

         

        Page 1 of
2   - WELLCARE_OF NEW YORK, INC. - H3361 -
09/01/2009

      


      
        
           


        

        
           


          
            

          

        

        
           


        

      

      
        


      

      
        	
                /s/
      Heath Schiesser

              	 
      	
                9/4/09

              	 
	
                CEO:

                Heath
      Schiesser

                CEO/President

                8735
      Henderson Road

                Tampa,
      FL 33634

                813-290-6205

              	 
      	
                Date:

              	 
	 
      	 
      	 
      	 
	 
      	 
      	 
      	 
	
                /s/
      Thomas L. Tran

              	 
      	
                9/4/09

              	 
	
                CFO:

                Tom
      Tran

                CFO

                8735
      Henderson Road

                Tampa,
      FL 33634

                813-290-6200
      (1770)

                 

              	 
      	
                Date:

              	 


      

      
        Medicare
Advantage benefit attestations should be sent by overnight carrier
to:

      

      
         

        Centers
for Medicare & Medicaid Services

      

      
        ATTN:
Marilyn Hunter/Medicare Advantage Benefit Attestation

      

      
        Mail Stop
C4-22-04

      

      
        7500
Security Boulevard

      

      
        Baltimore,
MD 21244-1850

         

         

         

        Page 2 of
2   - WELLCARE_OF NEW YORK, INC. - H3361 -
09/01/2009