h0117cmsrenwal.htm


    Back to Form 8-K

    Exhibit 10.3


    
      Medicare
Advantage Attestation of Benefit Plan

    

    
      WELLCARE
OF OHIO, INC.

    

    
      H0117

    

    
      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

              

            
	
              
                005

              

            	
              
                0

              

            	
              
                5

              

            	
              
                WellCare
      Value 

                (HMO)

              

            	
              
                HMO

              

            	
              
                Renewal

              

            	
              
                0.00

              

            	
              
                0.00

              

            	
              
                08/31/2009

              

            	
              
                01/01/2010

              

            
	
              
                007

              

            	
              
                0

              

            	
              
                5

              

            	
              
                WellCare
      Access 

                (HMO)

              

            	
              
                HMO

              

            	
              
                Renewal

              

            	
              
                0.00

              

            	
              
                30.50

              

            	
              
                08/31/2009

              

            	
              
                01/01/2010

              

            


    

    
       

       

       

       

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              /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

       

       

       

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