attestationh1032.htm


Back to Form 8-K




Medicare Advantage Attestation of Benefit Plan


 


WELL CARE OF FLORIDA, INC.


 


H1032


 







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 2012. 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 2011 and 2012, including but not limited to, the 2012 Call Letter, the 2012 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

	
31.00

	
4.60

	
09/02/2011

	
01/01/2012


	
008

	
0

	
5

	
WellCare Choice (HMO)

	
HMO 

	
Renewal

	
0.00

	
0.00

	
09/02/2011

	
01/01/2012


	
012

	
0

	
6

	
WellCare Choice (HMO- POS)

	HMOPOS	
Renewal

	
0.00

	
0.00

	
09/02/2011

	
01/01/2012


	
014

	
0

	
6

	
WellCare Choice (HMO- POS)

	
HMOPOS

	
Renewal

	
0.00

	
0.00

	
09/02/2011

	
01/01/2012


	
025

	
0

	
6

	
WellCare Choice (HMO- POS)

	HMOPOS	
Renewal

	
46.90

	
2.60

	
09/02/2011

	
01/01/2012


	
032

	
0

	
6

	
  WellCare Dividend 


(HMO)

	
HMO 

	
Renewal

	
0.00

	
0.00

	
09/02/2011

	
01/01/2012


	
035

	
0

	
6

	
  WellCare Value (HMO-


POS)

	HMOPOS  	
Renewal

	
0.00

	
0.00

	
09/02/2011

	
01/01/2012


	
037

	
0

	
6

	
WellCare Advance 


(HMO)

	
HMO 

	
Renewal

	
0.00

	
N/A

	
09/02/2011

	
01/01/2012


	
040

	
0

	
6

	
  WellCare Dividend


(HMO)

	
HMO 

	
Renewal

	
0.00

	
0.00

	
09/02/2011

	
01/01/2012


	
061

	
0

	
6

	
WellCare Select (HMO- 


POS SNP)

	HMOPOS  	
Renewal

	
0.00

	
18.10

	
09/02/2011

	
01/01/2012


	
073

	
0

	
6

	
WellCare Value (HMO-


POS)  

	  HMOPOS  	
Renewal

	
0.00

	
0.00

	
09/02/2011

	
01/01/2012


	
079

	
0

	
6

	WellCare Value (HMO)  	  HMO	
Renewal

	
0.00

	
0.00

	
09/02/2011

	
01/01/2012


	
091

	
0

	
6

	
  WellCare Value (HMO-


POS)

	HMOPOS	
Renewal

	
0.00

	
0.00

	
09/02/2011

	
01/01/2012







 


 


 


 


 


                                        




	 	 	 	 H1032





      




  





  











  












	
Plan 


ID

	
Segment


ID

	
Version

	
Plan Name

	
Plan


Type

	
Transaction 


Type

	
MA 


Premium

	
Part D 


Premium

	
CMS Approval 


Date

	
Effective 


Date


	
101

	
0

	
6

	
WellCare Select (HMO-


POS SNP)

	
HMOPOS

	
Renewal

	
0.00

	
23.80

	
09/02/2011

	
01/01/2012


	
124

	
0

	
6

	
WellCare Access (HMO 


SNP)

	
HMO

	
Renewal

	
0.00

	
19.20

	
09/02/2011

	
01/01/2012


	
131

	
0

	
8

	
WellCare Dividend


(HMO)

	
HMO

	
Renewal

	
0.00

	
0.00

	
09/02/2011

	
01/01/2012


	
132

	
0

	
6

	
WellCare Value (HMO-


POS)

	
HMOPOS

	
Renewal

	
0.00

	
0.00

	
09/02/2011

	
01/01/2012


	
133

	
0

	
6

	
WellCare Essential 


(HMO)

	
HMO

	
Renewal

	
0.00

	
0.00

	
09/02/2011

	
01/01/2012


	
170

	
0

	
7

	
WellCare Access (HMO-


SNP)

	
HMO

	
Renewal

	
0.00

	
23.80

	
09/02/2011

	
01/01/2012


	
173

	
0

	
7

	
WellCare Essential 


(HMO)

	
HMO

	
Renewal

	
0.00

	
0.00

	
09/02/2011

	
01/01/2012


	
174

	
0

	
7

	
WellCare Essential 


(HMO)

	
HMO

	
Renewal

	
0.00

	
0.00

	
09/02/2011

	
01/01/2012







 


 


 


 


 


                                        




	 	 	 	 H1032





                 




  





  











  













	
THOMAS TRAN


 

	 	 9/1/2011 10:35:08 AM	 
	
 


Contracting Official Name 

	 	 Date	 





 


 


 


 




	
WELL CARE OF FLORIDA, INC.


 

	 	
8735 Henderson Rd


Tampa, FL 33634


 

	 
	
 


Organization 

	 	
 


Address

	 





                    


 


 


 


 


                                                         


	 	 	 	 H1032