exhibit10-1.htm


    
      
        

      

    

    Back
      to Form 8-K

     

    Exhibit
      10.1

     

     

    NOTICE
      OF AWARD

     

    State
      of Missouri

    Office
      of Administration

    Division
      of Purchasing and Materials
      Management

    PO
      Box 809

    Jefferson,
      City, MO
      65102

    http://www.oa.mo.gov/purch

    
      

        
          	
                  CONTRACT
                    NUMBER

                  C306118005

                	
                  CONTRACT
                    TITLE

                  Medicaid
                    Managed Care-Eastern Region

                
	
                  AMENDMENT
                    NUMBER

                  Amendment
                    #005

                	
                  CONTRACT
                    PERIOD

                  July
                    1, 2007 through June 30, 2008

                
	
                  REQUISITION
                    NUMBER

                  NR
                    886 25758003595

                	
                  VENDOR
                    NUMBER

                  3640504950
                    1

                
	
                  CONTRACTOR
                    NAME AND ADDRESS

                  HARMONY
                    HEALTH PLAN, INC.

                  23
                    PUBLIC SQUARE SUITE 400

                  BELLEVILLE,
                    IL 62220

                   

                	
                  STATE
                    AGENCY NAME AND ADDRESS

                  Dept
                    of Social Services

                  Division
                    of Medical Services

                  P.O
                    Box 6500

                  Jefferson
                    City, MO 65102

                
	
                  ACCEPTANCE
                    BY THE STATE OF MISSOURI AS FOLLOWS:

                  Contract
                    C306118005 is hereby amended pursuant to the attached Amendment
                    #005 dated
                    9/24/07

                
	
                  BUYER

                  Laura
                    Ortmeyer

                   

                	
                  BUYER
                    CONTACT INFORMATION

                  Email:
                    laura.ortmeyer@oa.mo.gov

                  Phone:
                    (573) 751-4579 Fax (573) 526-9817

                
	
                  SIGNATURE
                    OF BUYER

                  /s/   Laura
                    Ortmeyer

                	
                  DATE

                  9/25/07

                
	
                  DIRECTOR
                    OF PURCHASING AND MATERIALS MANAGEMENT

                  /s/
                    James Miluski

                  James
                    Miluski

                	 


        

      

       

    

     

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

     

    STATE
      OF MISSOURI

    OFFICE
      OF ADMINISTRATION

    DIVISION
      OF PURCHASING AND MATERIALS MANAGEMENT (DPMM)

    CONTRACT
      AMENDMENT


    


    
      	AMENDMENT
              NO.:  005          	 REQ
              NO.: NR 886
              25758003595
	CONTRACT
              NO.:  C306118005	 BUYER:  Laura
              Ortmeyer
	TITLE:  Medicaid
              Managed Care – Eastern
              Region	 PHONE
              NO.:  (573)
              751-4579
	 ISSUE
              DATE:  09/19/07	 E-MAIL:  laura.ortmeyer@oa.mo.gov


    

    


    TO:        HARMONY
      HEALTH PLAN INC

    23
      PUBLIC SQUARE STE
      400

    BELLEVILLE
      IL  62220

    


    RETURN
      AMENDMENT NO LATER THAN:  SEPTEMBER 24, 2007 AT 5:00 PM
      CENTRAL TIME

     

    RETURN
      AMENDMENT TO:

    
      	
              (U.S.
                Mail)

              Div
                of Purchasing & Matls Mgt
                (DPMM)    OR

              PO
                BOX 809

              JEFFERSON
                CITY MO  65102-0809

            	
              (Courier
                Service)

              Div
                of Purchasing & Matls Mgt (DPMM)

              301
                WEST HIGH STREET, ROOM 630

              JEFFERSON
                CITY
                MO  65101-1517

            


    

    


    OR
      FAX TO: (573) 526-9817 (either mail or fax, not
      both)

    


    DELIVER
      SUPPLIES/SERVICES FOB (Free On Board) DESTINATION TO THE FOLLOWING
      ADDRESS:

    


    Department
      of Social Services, MO HealthNet Division

    Post
      Office Box 6500

    Jefferson
      City MO  65102-6500

    


    SIGNATURE
      REQUIRED

    


    
      	
              DOING
                BUSINESS AS (DBA) NAME

              Harmony
                Health Plan of Illinois Inc., d/b/a/ Harmony Health Plan of
                Missouri

            	 	
              LEGAL
                NAME OF ENTITY/INDIVIDUAL FILED WITH IRS FOR THIS TAX ID
                NO.

              Harmony
                Health Plan of Illinois, Inc.

            
	
              MAILING
                ADDRESS

              23
                Public Square, Suite 400

            	
              IRS
                FORM 1099 MAILING ADDRESS

              200
                West Adams Street, Suite 800

            
	
              CITY,
                STATE, ZIP CODE

              Belleville,
                IL 62220

            	
              CITY,
                STATE, ZIP CODE

              Chicago,
                IL 60606

            


    

    


    
      	
              CONTACT
                PERSON

              Ms.
                Tina Gallagher

            	
              EMAIL
                ADDRESS

              Tina.Gallagher@wellcare.com

            
	
              PHONE
                NUMBER

              (800)
                608-8158 Ext. 2405

            	
              FAX
                NUMBER

              (800)
                608-8157

            
	
              TAXPAYER
                ID NUMBER (TIN)

              36-4050495

            	
               TAXPAYER
                ID (TIN) TYPE (CHECK ONE)

                          _X__ FEIN       ___
                SSN

            	
              VENDOR
                NUMBER (IF KNOWN)

              3640504950
                1

            
	
              VENDOR
                TAX FILING TYPE WITH IRS (CHECK ONE)   (NOTE:  LLC
                IS NOT A VALID TAX FILING TYPE.)

               _X__
                Corporation         ___
                Individual         ___ State/Local
                Government         ___ Partnership         ___
                Sole
                Proprietor         ___Other
                ________________

            
	
              AUTHORIZED
                SIGNATURE

               
/s/  
Thaddeus
                Bereday                 
                

            	
              DATE

              September
                24, 2007

            
	
              PRINTED
                NAME

              Thaddues
                Bereday

            	
              TITLE

              Secretary

            


    

    


    
      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

          
          

        

      

    

    AMENDMENT
      #005 CONTRACT C306118005

    


    CONTRACT
      TITLE: Medicaid Managed Care – Eastern Region

    


    CONTRACT
      PERIOD: July 1, 2007 through June 30, 2008

    


    The
      State
      of Missouri hereby desires to amend the above-referenced contract, as
      follows.

    


    
      	
              1.  
                

            	
              Effective
                September 1, 2007, the State of Missouri's medical assistance program
                on
                behalf of needy persons shall be known as "MO HealthNet".  All
                references to Medicaid shall hereinafter be referred to as "MO
                HealthNet".  The Division of Medical Services (DMS) is
                hereinafter referred to as the "MO HealthNet Division
                (MHD)".  Individuals eligible under "MO HealthNet" shall be
                referred to as participants.

            


    

    


    
      	
              2.  

            	
              Subparagraphs
                a. through c. of paragraph 1.1.1 of the RFP portion of the contract
                is
                hereby amended effective January 1, 2008 as
                follows:

            


    

    


    
      	
               

            	
              1.1.1

            	
              This
                document constitutes a request for competitive, sealed proposals
                from the
                health plan provider community for becoming providers in the Missouri
                managed care program, hereinafter referred to as "MC+ managed care"
                in the
                following regions of the State of
                Missouri:

            


    

    


    
      	
               

            	
              a.

            	
              Central
                Region: Audrain, Benton, Boone, Callaway, Camden, Chariton, Cole,
                Cooper,   Dallas, Gasconade, Hickory, Howard, Laclede,
                Linn, Macon, Maries, Marion, Miller, Moniteau, Monroe, Montgomery,
                Morgan,
                Osage, Pettis, Phelps, Pulaski, Ralls, Randolph, Saline and Shelby
                counties.

            


    

    


    
      	
               

            	
              b.

            	
              Eastern
                Region:  Crawford, Franklin, Iron, Jefferson, Lincoln, Madison,
                Perry, Pike, St. Charles, St. Francois, Ste. Genevieve, St. Louis,
                Warren
                and Washington counties and St. Louis
                City.

            


    

    


    
      	
               

            	
              c.

            	
              Western
                Region:  Bates, Cass, Cedar, Clay, Henry, Jackson, Johnson,
                Lafayette, Platte, Polk, Ray, St. Clair, and Vernon
                counties.

            


    

    


    
      	
              3.

            	
              Paragraph
                1.5.1 of the RFP portion of the contract is hereby amended effective
                January 1, 2008 as follows:

            


    

    


    
      	
               

            	
              1.5.1

            	
              Effective
                July 1, 2006, the State of Missouri will continue a health care delivery
                program in Audrain, Boone, Callaway, Camden, Cass, Chariton, Clay,
                Cole,
                Cooper, Franklin, Gasconade, Henry , Howard, Jackson, Jefferson,
                Johnson,
                Lafayette, Lincoln, Miller, Moniteau, Monroe, Montgomery, Morgan,
                Osage,
                Pettis, Platte, Randolph, Ray, Saline, St. Charles, St. Clair, St.
                Francois, Ste, Genevieve, St. Louis, Warren and Washington counties
                and
                St. Louis City to serve MC+ managed care eligibles meeting specified
                eligibility criteria.  Effective January 1, 2008, the State of
                Missouri will introduce the MC+ Managed Care Program in twenty-one
                (21)
                counties contiguous to the existing MC+ Managed Care
                regions.  The new counties are:  Bates, Benton, Cedar,
                Crawford, Dallas, Hickory, Iron, Laclede, Linn, Macon, Madison, Maries,
                Marion, Perry, Phelps, Pike, Polk, Pulaski, Ralls, Shelby, and
                Vernon.  The goal is to improve the accessibility and quality of
                health care services for Missouri's MC+ managed care and State aid
                eligible populations, while controlling the program's rate of cost
                increase.

            


    

    


    
      	
              4.

            	
              Paragraph
                2.1.3 and subparagraphs a. through j. of the RFP portion of the contract
                is hereby amended and subparagraphs k. through o. are hereby added
                effective January 1, 2008 as
                follows:

            


    

    


    
      	
               

            	
              2.1.3

            	
              The
                health plan awarded a contract for the Eastern region shall provide
                services to individuals determined eligible by the state agency for
                the
                Missouri MC+ Managed Care Program in all of the following fifteen
                areas in
                the State of Missouri:

            


    

    


    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    
      	
               

            	
              a.

            	
              Crawford
                County

            


    

    
      	
               

            	
              b.

            	
              Franklin
                County

            


    

    
      	
               

            	
              c.

            	
              Iron
                County

            


    

    
      	
               

            	
              d.

            	
              Jefferson
                County

            


    

    
      	
               

            	
              e.

            	
              Lincoln
                County

            


    

    
      	
               

            	
              f.

            	
              Madison
                County

            


    

    
      	
               

            	
              g.

            	
              Perry
                County

            


    

    
      	
               

            	
              h.

            	
              Pike  County

            


    

    
      	
               

            	
              i.

            	
              St.
                Charles County

            


    

    
      	
               

            	
              j.

            	
              St.
                Francois County

            


    

    
      	
               

            	
              k.

            	
              Ste.
                Genevieve County

            


    

    
      	
               

            	
              l.

            	
              St.
                Louis County

            


      	 	m.	Warren
              County


    

    
      	
               

            	
              n.

            	
              Washington
                County

            


    

    
      	
               

            	
              o.

            	
              St.
                Louis City

            


    

    


    
      	
              5.

            	
              Paragraph
                2.1.4 and subparagraphs a. through r. of the RFP portion of the contract
                is hereby amended and subparagraphs s. through dd. are hereby added
                effective January 1, 2008 as
                follows:

            


    

    


    
      	
               

            	
              2.1.4

            	
              The
                health plan awarded a contract for the Central region shall provide
                services to individuals determined eligible by the state agency for
                the
                Missouri MC+ Managed Care Program in all of the following thirty
                areas in
                the State of Missouri:

            


    

    


    
      	
               

            	
              a.

            	
              Audrain
                County

            


    

    
      	
               

            	
              b.

            	
              Benton
                County

            


    

    
      	
               

            	
              c.

            	
              Boone
                County

            


    

    
      	
               

            	
              d.

            	
              Callaway
                County

            


    

    
      	
               

            	
              e.

            	
              Camden
                County

            


    

    
      	
               

            	
              f.

            	
              Chariton
                County

            


    

    
      	
               

            	
              g.

            	
              Cole
                County

            


    

    
      	
               

            	
              h.

            	
              Cooper
                County

            


    

    
      	
               

            	
              i.

            	
              Dallas
                County

            


    

    
      	
               

            	
              j.

            	
              Gasconade
                County

            


    

    
      	
               

            	
              k.

            	
              Hickory
                County

            


    

    
      	
               

            	
              l.

            	
              Howard
                County

            


      	 	m.	Laclede
              County


      	 	n.	Linn
              County


    

    
      	
               

            	
              o.

            	
              Macon
                County

            


    

    
      	
               

            	
              p.

            	
              Maries
                County

            


    

    
      	
               

            	
              q.

            	
              Marion
                County

            


    

    
      	
               

            	
              r.

            	
              Miller
                County

            


    

    
      	
               

            	
              s.

            	
              Moniteau
                County

            


    

    
      	
               

            	
              t.

            	
              Monroe
                County

            


    

    
      	
               

            	
              u.

            	
              Montgomery
                County

            


    

    
      	
               

            	
              v.

            	
              Morgan
                County

            


      	 	w.	Osage
              County


    

    
      	
               

            	
              x.

            	
              Pettis
                County

            


    

    
      	
               

            	
              y.

            	
              Phelps
                County

            


    

    
      	
               

            	
              z.

            	
              Pulaski
                County

            


      	 	aa.	Ralls
              County


      	 	bb.	Randolph
              County


      	 	cc.	Saline
              County


      	 	dd.	Shelby
              County


      	 	 	 


    

     

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    
      	
              6.

            	
              Paragraph
                2.1.5 and subparagraphs a. through i. of the RFP portion of the contract
                is hereby amended and subparagraphs j. through m. are hereby added
                effective January 1, 2008 as
                follows:

            


    

    


    
      	
               

            	
              2.1.5

            	
              The
                health plan awarded a contract for the Western region shall provide
                services to individuals determined eligible by the state agency for
                the
                Missouri MC+ Managed Care Program in all of the following thirteen
                areas
                in the State of Missouri:

            


    

    


    
      	
               

            	
              a.

            	
              Bates
                County

            


    

    
      	
               

            	
              b.

            	
              Cass
                County

            


    

    
      	
               

            	
              c.

            	
              Cedar
                County

            


    

    
      	
               

            	
              d.

            	
              Clay
                County

            


    

    
      	
               

            	
              e.

            	
              Henry
                County

            


    

    
      	
               

            	
              f.

            	
              Jackson
                County

            


    

    
      	
               

            	
              g.

            	
              Johnson
                County

            


    

    
      	
               

            	
              h.

            	
              Lafayette
                County

            


    

    
      	
               

            	
              i.

            	
              Platte
                County

            


    

    
      	
               

            	
              j.

            	
              Polk
                County

            


    

    
      	
               

            	
              k.

            	
              Ray
                County

            


    

    
      	
               

            	
              l.

            	
              St.
                Clair County

            


      	 	m.	Vernon
              County


    

     

    
      	
              7.

            	
              Paragraph
                2.4.6 of the RFP portion of the contract is hereby amended effective
                July
                1, 2007 as follows:

            


    

    


    
      	
               

            	
              2.4.6

            	
              Pharmacy
                Dispensing Fee:  The health plan shall pay a pharmacy
                dispensing fee of $4.84 to each qualifying pharmacy for the first
                1,000
                prescriptions filled in any calendar quarter.  The reimbursement
                of a pharmacy dispensing fee shall be available only to corporations,
                partnerships, or individual proprietorships with less than 25 employees
                who operate pharmacies or pharmacy franchises and to public health
                entities owned and operated by a state, county or local government
                agency
                and where the entity is a hospital which qualifies as a first-tier
                10%
                add-on disproportionate share hospital in accordance with 13 CSR
                70-15.010.  The health plan shall identify its pharmacies that
                qualify.  The health plan shall supply the state agency with a
                list of those pharmacies identified to qualify for a pharmacy dispensing
                fee reimbursement upon request.

            


    

    


    
      	
              8.

            	
              Paragraph
                2.4.9 of the RFP portion of the contract is hereby amended and
                subparagraphs a. through c. are hereby added effective July 1, 2007
                as
                follows:

            


    

    


    
      	
               

            	
              2.4.9

            	
              The
                health plan shall maintain the fee schedule for office visit services
                and
                dental services located in Attachment 14 at no lower than the Medicaid
                fee-for-service fee schedule in effect the time of service.  The
                fee schedule for office visit services included in Attachment 14
                are for
                dates of services July 1, 2006 through June 30,
                2007.

            


    

    


    
      	
               

            	
              a.

            	
              The
                Missouri 94th
                General
                Assembly approved a statutory change for the state agency to develop
                a
                four-year plan to achieve parity with Medicare reimbursement rates
                for
                physicians which was signed by the Governor on July 2,
                2007.  The statutory change affects MC+ Managed Care
                reimbursement rates.

            


    

    


    
      	
               

            	
              b.

            	
              A
                physician fee increase will be implemented effective July 1,
                2007.  Physician reimbursement rates that are currently less
                than 55% of the Medicare reimbursement rate will increase to 55%,
                physician reimbursement rates currently at 55% will remain unchanged,
                and
                physician reimbursement rates currently more than 55% will be increased
                by
                10%, but shall not exceed the Medicare rate.  The state agency’s
                Online Fee-For-Service Fee Schedule is available electronically
                at:  http//www.dss.mo.gov/mhd/providers/pages/cptagree.htm.

            


    

    


    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

    

    
      	
               

            	
              c.

            	
              Effective
                July 1, 2007, the health plan shall increase the rates for physician
                services provided to MC+ enrollees in accordance with the fee-for-service
                rate increases.  The health plan's capitation rates will be
                increased July 1, 2007 to reflect the increases for physician
                services.  The health plan shall request and receive proof from
                its health care services subcontractors that these increases have
                been
                passed on to providers beginning July 1, 2007.  Such proof shall
                be provided to the state agency upon
                request.

            


    

    


    
      	
              9.

            	
              Paragraph
                2.7.1 r. of the RFP portion of the contract is hereby amended effective
                September 1, 2007 as follows:

            


    

    


    
      	
               

            	
              r.

            	
              Durable
                medical equipment (including but not limited to: orthotic and prosthetic
                devices, respiratory equipment and oxygen, enteral and parenteral
                nutrition, wheelchairs and walkers, and diabetic supplies and
                equipment);

            


    

    


    
      	
              10.

            	
              Paragraph
                2.7.3 e. of the RFP portion of the contract is deleted effective
                September
                1, 2007.

            


    

    


    
      	
              11.

            	
              Paragraph
                2.28.2 d. and subparagraphs 1) and 2) of the RFP portion of the contract
                is hereby amended effective July 1, 2007 as
                follows:

            


    

    


    
      	
               

            	
              d.

            	
              The
                first time a health plan achieves an average of low with a value
                of one
                (1), the state agency shall notify the health plan of the health
                plan's
                rating and shall give the health plan ten (10) working days to develop
                an
                acceptable action plan to improve the substandard
                performance.

            


    

    


    
      	
               

            	
              1)

            	
              If
                the health plan submits an action plan for correcting the rating
                and if
                the plan is acceptable to the state agency, no action shall be taken
                at
                that time, provided the health plan implements the corrective action
                plan
                as approved by the state agency.

            


    

    


    
      	
               

            	
              2)

            	
              If
                the health plan fails to submit an action plan within ten (10) working
                days or the health plan does not implement the corrective action
                plan
                within the time frame stated in the action plan, the state agency
                shall
                inform enrollees in enrollment materials that the health plan failed
                to
                achieve the minimum performance
                standard.

            


    

    


    
      	
              12.

            	
              Attachment
                1 is hereby revised effective July 1,
                2007.

            


    

    


    
      	
              13.

            	
              Attachment
                3 is hereby revised effective September 1,
                2007.

            


    

    


    
      	
              14.

            	
              Attachment
                5 is hereby revised effective January 1,
                2008.

            


    

    


    
      	
              15.

            	
              Attachment
                9 is hereby revised effective July 1,
                2007.

            


    

    


    
      	
              16.

            	
              Attachment
                13 is hereby revised effective July 1,
                2007.

            


    

    


    
      	
              17.

            	
              Attachment
                14 is hereby revised effective July 1,
                2007.

            


    

    


    The
      contractor shall indicate in Column 2 on the attached Pricing page, any changes
      to the firm, fixed prices of the contract for performing the required services
      in accordance with the terms, conditions, and provisions of the contract,
      including the above stated changes.  The contractor's firm, fixed PMPM
      Net Capitation Rate for Each Category of Aid (COA) Rate subgroup must not exceed
      the State's Maximum Net Capitation Rate listed in Column 1.

    


    All
      other
      terms, conditions and provisions of the contract shall remain the same and
      apply
      hereto.

    


    The
      contractor shall sign and return this document, on or before the date indicated,
      signifying acceptance of the amendment.

     

    

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      5.3
        East Region - Firm Fixed Net Capitation Pricing Page 

       

    

    
      
        	
                July
                  1, 2007       

              
	
                 

              	
                 

              	
                 

              	
                Column
                  1

              	 	
                Column
                  2

              
	 
                
                Category
                  of Aid

              	 
                
                Age

              	 
                
                Sex

              	
                State's
                  Maximum Net Capitation Rate

                (Per
                  Member, Per Month)

              	
                Firm
                  Fixed Net 

                Capitation
                  Rate

                (Per
                  Member, Per Month)

              
	
                1

              	
                Newborn
                  < 01

              	
                Male
                  and Female

              	
                $

              	
                $868.66

              	 	
                $

              	
                $868.66

              
	
                1

              	
                01
                  - 06

              	
                Male
                  and Female

              	
                $

              	
                $127.23

              	 	
                $

              	
                $127.23

              
	
                1

              	
                07
                  - 13

              	
                Male
                  and Female

              	
                $

              	
                $98.89

              	 	
                $

              	
                $98.89

              
	
                1

              	
                14
                  - 20

              	
                Female

              	
                $

              	
                $310.96

              	 	
                $

              	
                $310.96

              
	
                1

              	
                14
                  - 20

              	
                Male

              	
                $

              	
                $127.02

              	 	
                $

              	
                $127.02

              
	
                1

              	
                21
                  - 44

              	
                Female

              	
                $

              	
                $423.51

              	 	
                $

              	
                $423.51

              
	
                1

              	
                21
                  - 44

              	
                Male

              	
                $

              	
                $192.66

              	 	
                $

              	
                $192.66

              
	
                1

              	
                45
                  - 99

              	
                Male
                  and Female

              	
                $

              	
                $442.89

              	 	
                $

              	
                $442.89

              
	
                4

              	
                00
                  - 20

              	
                Male
                  and Female

              	
                $

              	
                $234.35

              	 	
                $

              	
                $234.35

              
	 	 	 	 	 	 	 	 
	
                5

              	
                00
                  - 06

              	
                Male
                  and Female

              	
                $

              	
                $155.61

              	 	
                $

              	
                $155.61

              
	
                5

              	
                07
                  - 13

              	
                Male
                  and Female

              	
                $

              	
                $119.20

              	 	
                $

              	
                $119.20

              
	
                5

              	
                14
                  - 18

              	
                Male
                  and Female

              	
                $

              	
                $177.30

              	 	
                $

              	
                $177.30

              


      

      

        
          	
                  January
                    1, 2008       

                
	
                   

                	
                   

                	
                   

                	
                  Column
                    1

                	 	
                  Column
                    2

                
	 
                  
                  Category
                    of Aid

                	 
                  
                  Age

                	 
                  
                  Sex

                	
                  State's
                    Maximum Net Capitation Rate

                  (Per
                    Member, Per Month)

                	
                  Firm
                    Fixed Net 

                  Capitation
                    Rate

                  (Per
                    Member, Per Month)

                
	 	 	 	 	 	 	 	 
	
                  1

                	
                  Newborn
                    < 01

                	
                  Male
                    and Female

                	
                  $

                	
                  $905.59

                	 	
                  $

                	
                  $905.59

                
	
                  1

                	
                  01
                    - 06

                	
                  Male
                    and Female

                	
                  $

                	
                  $130.22

                	 	
                  $

                	
                  $130.22

                
	
                  1

                	
                  07
                    - 13

                	
                  Male
                    and Female

                	
                  $

                	
                  $102.62

                	 	
                  $

                	
                  $102.62

                
	
                  1

                	
                  14
                    - 20

                	
                  Female

                	
                  $

                	
                  $319.80

                	 	
                  $

                	
                  $319.80

                
	
                  1

                	
                  14
                    - 20

                	
                  Male

                	
                  $

                	
                  $131.24

                	 	
                  $

                	
                  $131.24

                
	
                  1

                	
                  21
                    - 44

                	
                  Female

                	
                  $

                	
                  $436.19

                	 	
                  $

                	
                  $436.19

                
	
                  1

                	
                  21
                    - 44

                	
                  Male

                	
                  $

                	
                  $199.49

                	 	
                  $

                	
                  $199.49

                
	
                  1

                	
                  45
                    - 99

                	
                  Male
                    and Female

                	
                  $

                	
                  $457.88

                	 	
                  $

                	
                  $457.88

                
	
                  4

                	
                  00
                    - 20

                	
                  Male
                    and Female

                	
                  $

                	
                  $244.13

                	 	
                  $

                	
                  $244.13

                
	 	 	 	 	 	 	 	 
	
                  5

                	
                  00
                    - 06

                	
                  Male
                    and Female

                	
                  $

                	
                  $159.93

                	 	
                  $

                	
                  $159.93

                
	
                  5

                	
                  07
                    - 13

                	
                  Male
                    and Female

                	
                  $

                	
                  $124.16

                	 	
                  $

                	
                  $124.16

                
	
                  5

                	
                  14
                    - 18

                	
                  Male
                    and Female

                	
                  $

                	
                  $183.21

                	 	
                  $

                	
                  $183.21