Document:

attestationh0712.htm

Back to Form 8-K

 

Medicare Advantage Attestation of Benefit Plan 

 

WELLCARE OF CONNECTICUT, INC. 

 

H0712

 

 

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

	
001

	
0

	
8

	
WellCare Choice

(HMO-POS)

	
HMOPOS

	
Renewal

	
37.50

	
11.50

	
09/02/2011

	
01/01/2012

	
005

	
0

	
7

	
WellCare Access

(HMO SNP)

	
HMO

	
Renewal

	
0.00

	
32.00

	
09/02/2011

	
01/01/2012

	
019

	
0

	
8

	
Wellcare Value (HMO)

	
HMO

	
Renewal

	
0.00

	
0.00

	
09/02/2011

	
01/01/2012

 

 

 

 

 

 

	 	 	 	 H0712

                                                                        

  

  

  

 

 

 

 

	
THOMAS TRAN

 

	 	
9/1/2011 10:31:57 AM

	 
	
 

Contracting Official Name 

	 	 Date	 

 

 

 

 

	

WELLCARE OF CONNECTICUT, INC.

	 	
116 WASHINGTON AVENUE 

NORTH HAVEN, CT 06437

	 
	
 

Organization 

	 	
 

Address

	 

                    

 

 

 

 

                                                         

	 	 	 	 H0712attestationh0913.htm

Back to Form 8-K

Medicare Advantage Attestation of Benefit Plan 

 

WELLCARE HEALTH PLANS OF NEW JERSEY, INC. 

 

H0913

 

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

	
7

	
WellCare 

Value

(HMO)

	
HMO 

	
Renewal

	
0.00

	
0.00

	
09/06/2011

	
01/01/2012

	
003

	
0

	
8

	
 WellCare 

Access

(HMO

SNP)

	HMO	
Renewal

	
0.00

	
36.00

	
09/06/2011

	
01/01/2012

 

 

 

 

 

 

	 	 	 	 H0913

                                                                         

 

  

  

  

 

 

	
THOMAS TRAN

 

	 	 9/1/2011 10:33:23 AM	 
	
 

Contracting Official Name 

	 	 Date	 

 

 

 

 

	
WELLCARE HEALTH PLANS OF NEW JERSEY, INC.

 

	 	

P.O. Box 26011 

Tampa, FL 336236011

 

	 
	  

Organization 

	 	 	
 

Address

	 

                    

 

 

 

 

                                                         

	 	 	 	 H0913attestationh1032.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

	 

                    

 

 

 

 

                                                         

	 	 	 	 H1032attestationh1112.htm

Back to Form 8-K

Medicare Advantage Attestation of Benefit Plan

 

WELLCARE OF GEORGIA, INC.

 

H1112

 

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

	
006

	
0

	
8

	
WellCare Access

 (HMO SNP)

	
HMO

	
Renewal

	
0.00

	
16.60

	
09/06/11

	
01/01/12

	
027

	
0

	
7

	
WellCare Value (HMO-

POS)

	
HMOPOS

	
Renewal

	
0.00

	
0.00

	
09/06/11

	
01/01/12

 

 

 

 

 

 

	 	 	 	 H1112

                         

  

  

  

	
THOMAS TRAN

 

	 	 9/1/2011 10:43:43 AM	 
	
 

Contracting Official Name 

	 	 Date	 

 

 

 

 

	
WELLCARE OF GEORGIA, INC.

 

	 	
8735 Henderson Rd

Ren 1 

Tampa, FL 33634

 

	 
	
 

Organization 

	 	
 

Address

	 

  

 

 

 

 

	 	 	 	 H1112

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