Document:

EX-10.5

Tatum CFO Partners, LLP

Amended Executive Services Agreement

October 4, 2005

Mr. Peter A. Deliso

LCC International, Inc.

7925 Jones Branch Drive

McLean, Virginia 22102

Dear Mr. Deliso:

Tatum CFO Partners, LLP (“Tatum”) understands that LCC International, Inc. (“the Company”) desires
to engage a partner of Tatum to serve as chief financial officer. This Executive Services
Agreement sets forth the conditions under which such services will be provided.

Services; Fees

Tatum will make available to the Company C.R. “Bob” Waldron (the “Tatum Partner”), who will serve
as chief financial officer of the Company. The Tatum Partner will become an employee and a duly
elected or appointed officer of the Company and subject to the supervision and direction of the CEO
of the Company, the board of directors of the Company, or both. Tatum will have no control or
supervision over the Tatum Partner.

The Company will pay the Tatum Partner directly a salary of $22,916.67 a month (“Salary”). Salary
may be increased from time to time, by the Company. Starting October 26, 2005, the Company will
pay directly to Tatum, as partial compensation for the resources provided, an amount equal to (i)
20% of Salary of the Tatum Partner during the first and second 12 months of the term of this
agreement, (ii) 12% of Salary during the third 12 months, and (iii) $1,000 per month during the
remainder of the term of this agreement.

The Tatum Partner will be eligible to receive Cash Bonuses under the Company’s executive incentive
compensation plan. The Tatum Partner will be eligible to receive Equity Bonuses under the
Company’s equity incentive plan. The Company will pay directly to Tatum 15% of any Cash Bonus paid
to the Tatum Partner during the term of this agreement. No payments will be due or payable by the
Company with respect to Equity Bonuses. For purposes hereof, (i) “Cash Bonus” means any cash bonus
that is paid to the Tatum Partner under the Company’s regular annual bonus program for Company
executives, (ii) “Equity Bonus” means any stock, option, warrant, or similar right that is granted
to or exercised by the Tatum Partner, in each case in connection with services rendered by the
Tatum Partner, and (iii) “Salary” means the regular monthly payments described above plus any
severance paid to the Tatum Partner during the term hereof, but excluding any Cash Bonus, Equity
Bonus, benefits (including medical benefits subsidy paid to Employee), and other compensation. All
compensation payable or deliverable to Tatum is referred to herein as the “Resource Fee.”

In lieu of the Tatum Partner participating in the Company-sponsored employee medical/dental
insurance benefit, the Tatum Partner will remain on his or her current medical/dental plan. The
Company will reimburse the Tatum Partner for amounts paid by the Tatum Partner for such
medical/dental insurance for himself and (where applicable) his family of up to $ 324.00 per month
upon presentation of reasonable documentation of premiums paid by the Tatum Partner. In accordance
with the U.S. federal tax law, such amount will not be considered reportable W-2 income, but
instead non-taxable benefits expense.

As an employee, the Tatum Partner will be eligible for any Company employee retirement and/or
401(k) plan and for vacation and holidays consistent with the Company’s policy as it applies to
senior management, and the Tatum Partner will be exempt from any delay periods otherwise required
for eligibility.

Payments; 

Payments to Tatum should be made by direct deposit through the Company’s payroll, or by an
automated clearing house (“ACH”) payment at the same time as payments are made to the Employee. If
such payment method is not available and payments are made by check, Tatum will issue invoices to
the Company, and the Company agrees to pay such invoices no later than ten (10) days after receipt
of invoices.

The Company will reimburse the Tatum Partner directly for out-of-pocket expenses incurred by the
Tatum Partner in providing services hereunder to the same extent that the Company is responsible
for such expenses of senior managers of the Company.

Converting to Permanent

The Company will have the opportunity to make the Tatum Partner a permanent member of Company
management at any time during the term of this agreement by entering into another form of Tatum
agreement, the terms of which will be negotiated at such time.

Hiring Tatum Partner Outside of Agreement

During the twelve (12)-month period following termination or expiration of this agreement, other
than in connection with conversion to a Permanent Employee under the previous paragraph, the
Company will not employ the Tatum Partner, or engage the Tatum Partner as an independent
contractor, to render services of substantially the same nature as those to be performed by the
Tatum Partner as contemplated by this agreement. The parties recognize and agree that a breach by
the Company of this provision would result in the loss to Tatum of the Tatum Partner’s valuable
expertise and revenue potential and that such injury will be impossible or very difficult to
ascertain. Therefore, in the event this provision is breached, Tatum will be entitled to receive
as liquidated damages an amount equal to twenty-five percent (25%) of the Tatum Partner’s
Annualized Compensation (as defined below), which amount the parties agree is reasonably
proportionate to the probable loss to Tatum and is not intended as a penalty. The amount will be
due and payable to Tatum upon written demand to the Company. For this purpose, ''Annualized
Compensation’’ will mean monthly Salary equivalent to what the Tatum Partner would receive on a
full-time basis multiplied by twelve (12), plus the maximum amount of any Cash Bonus for which the
Tatum Partner was eligible with respect to the then current bonus year, and which the Tatum Partner
had a reasonable opportunity to receive given any relevant performance or other criteria and/or the
Company’s then-current bonus practices, provided that such payment shall be pro rated on the basis
of the number of days the Tatum Partner actually performed services hereunder within the applicable
annual bonus period.

Termination

The Company may terminate this agreement, and the Tatum Partner’s employment, for any reason or for
no reason at anytime upon at least 30 days’ prior written notice to the Tatum Partner, such
termination to be effective on the date specified in the notice, provided that such date is no
earlier than 30 days from the date of delivery of the notice. Upon any such termination, the
company shall have no further obligation or liability hereunder except (a) the payment of any
Salary earned but unpaid as of the effective date of termination, and (b) the payment of any
Severance Payment due and payable under the following paragraph of this agreement. Likewise, Tatum
may terminate his employment for any reason upon at least 30 days’ prior written notice to the
Company, such termination to be effective on the date 30 days following the date of the notice.
The Tatum Partner will continue to render services (unless placed on leave for such period by the
Company) and to be paid during such 30-day period, regardless of who gives such notice. Tatum may
terminate this agreement immediately if the Company has not remained current in its obligations
under this letter or if the Company engages in or asks the Employee to engage in or to ignore any
illegal or unethical conduct.

This agreement will terminate immediately upon the death or disability of the Employee. For
purposes of this agreement, disability will be as defined by the applicable policy of disability
insurance or, in the absence of such insurance, by the Company’s Board of Directors acting in good
faith.

Tatum retains the right to terminate this agreement immediately if (1) the Company is engaged in or
asks the Tatum Partner to engage in or to ignore any illegal or unethical activity, (2) the Tatum
Partner dies or becomes disabled, (3) the Tatum Partner ceases to be a partner of Tatum for any
other reason, or (4) upon ten days advance written notice by Tatum of non-payment by the Company of
amounts due under this agreement, unless such amounts are paid. For purposes of this agreement,
disability will be as defined by the applicable policy of disability insurance or, in the absence
of such insurance, by Tatum’s management acting in good faith.

The Tatum Partner’s Salary will be prorated for the final pay period based on the number of days in
the final pay period up to the effective date of termination or expiration.

Severance Payment

In the event of termination of employment by the Company due to no fault of Tatum or the Tatum
Partner, the Employee will be entitled to receive severance benefits in accordance with the
Company’s then-current separation guidelines and practice for executives at the same level taking
into consideration tenure and other factors deemed relevant by the CEO and/or the Company’s Board
of Directors. The payment of such severance shall be contingent upon the Tatum Partner’s having
executed and delivered to the Company (i) a full waiver and release of any and all potential
claims, and (ii) assurances with respect to continuing obligations of non-competition and
confidentiality in a form acceptable to the Company, in each case in the form generally obtained by
the Company in consideration for severance benefits.

The Company will pay directly to Tatum an amount equal to the same percent that applies for Salary
above for any Severance Payments that the Company may make to the Tatum Partner. For purposes
hereof, “Severance Payment” means any payments made to the Tatum Partner by Company as a severance
benefit in connection with the termination of the Tatum Partner’s employment. With such payment,
the Company shall have no further obligation to Tatum or liability hereunder.

In the event that either party commits a breach of this agreement, other than for reasons described
in the above paragraph, and fails to cure the same within seven (7) days following delivery by the
non-breaching party of written notice specifying the nature of the breach, the non-breaching party
will have the right to terminate this agreement immediately effective upon written notice of such
termination.

Insurance

The Company will provide Tatum or the Tatum Partner with written evidence that the Company
maintains directors’ and officers’ insurance at no additional cost to the Tatum Partner, and the
Company will maintain such insurance at all times while this agreement remains in effect.

Disclaimers, Limitations of Liability & Indemnity

Tatum assumes no responsibility or liability under this agreement other than to render the services
called for hereunder and will not be responsible for any action taken by the Company in following
or declining to follow any of Tatum’s advice or recommendations. Tatum represents to the Company
that Tatum has conducted reasonable screening and background checks and investigation procedures
consistent with those procedures used by US public companies for similar positions with respect to
the Tatum Partner becoming a partner in Tatum, and the results of the same uncovered no possible
concerns. Tatum disclaims all other warranties, either express or implied. Without limiting the
foregoing, Tatum makes no representation or warranty as to the accuracy or reliability of reports,
projections, forecasts, or any other information derived from use of Tatum’s resources, and Tatum
will not be liable for any claims of reliance on such reports, projections, forecasts, or
information. Tatum will not be liable for any non-compliance of reports, projections, forecasts, or
information or services with federal, state, or local laws or regulations. Such reports,
projections, forecasts, or information or services are for the sole benefit of the Company and not
any unnamed third parties.

In the event that any partner of Tatum (including without limitation the Tatum Partner to the
extent not otherwise entitled in his or her capacity as an officer of the Company) is subpoenaed or
otherwise required to appear as a witness or Tatum or such partner is required to provide evidence,
in either case in connection with any action, suit, or other proceeding initiated by a third party
or by the Company against a third party, then the Company shall reimburse Tatum for the costs and
expenses (including reasonable attorneys’ fees) actually incurred by Tatum or such partner and
provide Tatum with compensation at Tatum’s customary rate for the time incurred.

The Company agrees that, with respect to any claims the Company may assert against Tatum in
connection with this agreement or the relationship arising hereunder, Tatum’s total liability will
not exceed two (2) months of Fees.

As a condition for recovery of any liability, the Company must assert any claim against Tatum
within three (3) months after discovery or sixty (60) days after the termination or expiration of
this agreement, whichever is earlier.

Neither party hereto will be liable in any event for incidental, consequential, punitive, or
special damages, including without limitation, any interruption of business or loss of business,
profit, or goodwill.

Arbitration

If the parties are unable to resolve any dispute arising out of or in connection with this
agreement, either party may refer the dispute to arbitration by a single arbitrator selected by the
parties according to the rules of the American Arbitration Association (“AAA”), and the decision of
the arbitrator will be final and binding on both parties. Such arbitration will be conducted by
the Northern Virginia office of the AAA. In the event that the parties fail to agree on the
selection of the arbitrator within thirty (30) days after either party’s request for arbitration
under this paragraph, the arbitrator will be chosen by AAA. The arbitrator may in his discretion
order documentary discovery but shall not allow depositions without a showing of compelling need.
The arbitrator will render his decision within ninety (90) days after the call for arbitration.
The arbitrator will have no authority to award punitive damages. Judgment on the award of the
arbitrator may be entered in and enforced by any court of competent jurisdiction. The arbitrator
will have no authority to award damages in excess or in contravention of this agreement and may not
amend or disregard any provision of this agreement, including this paragraph. Notwithstanding the
foregoing, either party may seek appropriate injunctive relief from a court of competent
jurisdiction, and either party may seek injunctive relief in any court of competent jurisdiction.

Miscellaneous

Tatum will be entitled to receive all reasonable costs and expenses incidental to the collection of
overdue amounts under this agreement, including but not limited to attorneys’ fees actually
incurred.

Neither the Company nor Tatum will be deemed to have waived any rights or remedies accruing under
this agreement unless such waiver is in writing and signed by the party electing to waive the right
or remedy. This agreement binds and benefits the respective successors of Tatum and the Company.

Neither party will be liable for any delay or failure to perform under this agreement (other than
with respect to payment obligations) to the extent such delay or failure is a result of an act of
God, war, earthquake, civil disobedience, court order, labor dispute, or other cause beyond such
party’s reasonable control.

The provisions concerning payment of compensation and reimbursement of costs and expenses,
limitation of liability, directors’ and officers’ insurance, and arbitration will survive the
expiration or any termination of this agreement.

This agreement will be governed by and construed in all respects in accordance with the laws of the
Commonwealth of Virginia, without giving effect to conflicts-of-laws principles.

The terms of this agreement are severable and may not be amended except in writing signed by the
party to be bound. This agreement amends and supercedes the Executive Services Agreement executed
by the parties as of April 19, 2005. If any portion of this agreement is found to be
unenforceable, the rest of the agreement will be enforceable except to the extent that the severed
provision deprives either party of a substantial benefit of its bargain.

Nothing in this agreement shall confer any rights upon any person or entity other than the parties
hereto and their respective successors and permitted assigns and the Tatum Partner.

Each person signing below is authorized to sign on behalf of the party indicated, and in each case
such signature is the only one necessary.

Bank Lockbox Mailing Address for Deposit and Fees:

	 
	Tatum CFO Partners, LLP
P.O. Box 403291
Atlanta, GA 30384-3291

	 	 	 
	Electronic Payment Instructions for Deposit and Fees:

	 
	 	 
	 

	 
	 	 
	Bank Name: Bank of America

Branch: Atlanta

Routing Number:

	 	

For ACH Payments: XXXXXXXXXX

For Wires: XXXXXXXXXX

Account Name: Tatum CFO Partners, LLP

Account Number: XXXXXXXXX

Please reference LCC International, Inc. in the body of the wire.

Please sign below and return a signed copy of this letter to indicate the Company’s agreement with
its terms and conditions.

We look forward to serving you.

Sincerely yours,

	 	 	 
	TATUM CFO PARTNERS, LLP	 	 
	/s/ Robert P. Hostetler     

	 	

	 

	 	

	Signature

Robert P. Hostetler

Area Managing Partner for TATUM CFO

PARTNERS, LLP

October 4, 2005     

	 	

Acknowledged and agreed by:
	 

	 	

	 
	 	 
	
 
	 	LCC International, Inc.
	 
	 	 
	
 
	 	/s/ Peter A. Deliso     
	
 
	 	 
	
 
	 	Signature

Peter A. Deliso

Interim Chief Executive Officer

October 4, 2005     
	
 
	 	 
	
 
	 	(Date)EX-10.1

Exhibit 10.1

MEDICAL SERVICES AGREEMENT

FLORIDA HEALTHY KIDS CORPORATION and

HEALTHEASE

For

Citrus, Duval, Escambia, Highlands, Jefferson, Lake, Madison, Martin, Putnam and Wakulla Counties

and

WELLCARE HMO/STAYWELL HEALTH PLAN

For

Brevard, Broward, Charlotte, Collier, Miami-Dade, Desoto, Hernando, Hillsborough, Lee, Manatee,

Orange, Osceola, Palm Beach, Pinellas, Sarasota and Seminole Counties

October 1, 2005 — Effective Date

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 1 of 44

FLORIDA HEALTHY KIDS CORPORATION

AGREEMENT FOR MEDICAL SERVICES

TABLE OF CONTENTS

	 	 	 	 	 	 	 	 	 	 	 
	SECTION	 	1	 	GENERAL PROVISIONS	 	 	 	 
	
 
	 	 	1-1	 	 	Definitions
	 	

	 	

	 
	 	 	 	 	 	 	 	 	 	 
	SECTION	 	 	2	 	 	FLORIDA HEALTHY KIDS CORPORATION RESPONSIBILITIES
	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	SECTION

	 	2-1

2-2

2-3

3

3-1

3-2

3-2-1
	 	Participant Identification

Payments

Reduced Fee Arrangements

2-3-1Specialty Fee Arrangements

2-3-2Children’s Medical Services

2-4Quarterly Program Updates

2-5 Change in Benefit Schedule

2-6Marketing

2-7Forms and Reports

2-8Coordination of Benefits

2-9Entitlement to Reimbursement

INSURER

Benefits

Access to Care

Access and Appointment Standards
	 	

	 	

	 
	 	 	 	 	 	 	 	 	 	 
	 	 	 	3-2-2	 	 	Integrity of Professional Advice to Enrollees
	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	
 
	 	3-3

3-4

3-5

3-6

3-7

3-8
	 	Fraud and Abuse

Membership Materials

Use of Name

Eligibility

Effective Date of Coverage

Termination of Participation
	 	

	 	

	 
	 	 	 	 	 	 	 	 	 	 
	 	 	 	3-9	 	 	Continuation of Coverage Upon Termination of this Agreement
	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	
 
	 	3-10

3-11

3-12

3-13

3-14

3-15

3-16

3-17
	 	Indi vidual Contracts

Refusal of Coverage

Extended Coverage

Grievances and Complaints

Claims Payment

Notification Requirements

Rates

Rate Modification

3-17-1 Annual Adjustment

3-17-2 Denial of Rate Request

3-18 Conditions of Services

3-19Medical Records Requirements

3-19-1Medical Quality Review and Audit

3-19-2 Privacy of Medical Records
	 	

	 	

	 
	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	3-19-3 Requests by Participants for Medical Records
	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	HEALTHEASE AND STAYWELL HMO
	 	 	 	 	 	Effective Date: October 1, 2005
	 
	 	 	 	 	 	 	 	 	 	 
	SECTION

	 	3-20

3-21

3-22

3-23

3-24

3-25

3-26

3-27

3-28

3-29

3-30

4

4-1

4-2

4-3

4-4
	 	Quality Enhancement

3-20-1 Authority

3-20-2 Staff

3-20-3 Peer Review

3-20-4 Referrals

Availability of Records

Audits

3-22-1 Accessibility of Records

3-22-2 Financial Audit

3-22-3 Post-Agreement Audit

3-22-4 Accessibility for Monitoring

Indemnification

Confidentiality of Information

Insurance

Lobbying Disclosure

Reporting Requirements

Participant Liability

Protection of Proprietary Information

Regulatory Filings

TERMS AND CONDITIONS

Effective Date

Multi-year Agreement

Entire Understanding

Relation to Other Laws
	 	Page 2 of 44

	 	

	 
	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	4-4-1 Health Insurance Portability and Accountability Act
	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	
 
	 	 	 	 	 	4-4-2 Mental Health Parity Act
	 	

	 	

	 
	 	 	 	 	 	 	 	 	 	 
	 	 	 	 	 	 	4-4-3 Newboms and Mothers Health Protection Act of 1996
	 	 
	 
	 	 	 	 	 	 	 	 	 	 
	
 
	 	4-5

4-6

4-7

4-8

4-9

4-10

4-11

4-12

4-13

4-14
	 	Independent Contractor

Assignment

Notice

Amendments

Governing Law

Agreement Variation

Attorney’s Fees

Representatives

Termination

Contingency
	 	

	 	

	 
	 	 	 	 	 	 	 	 	 	 
	HEALTHEASE AND STAYWELL HMO
	 	 	 	 	 	Effective Date: October 1, 2005
	 
	 	 	 	 	 	 	 	 	 	 
	SECTION

	 	 	5	 	 	EXHIBITS
	 	Page 3 of 44

	 	

Exhibit A: Premium Payment and Rates

Exhibit B: Enrollment Dates

Exhibit C: Benefits

Exhibit D: Coordination of Benefits

Exhibit E: Access Standards

Exhibit F: Eligibility

Exhibit G: Reporting Requirements

Exhibit H: Certification Regarding Debarment, Suspension and Involuntary Cancellation

Exhibit I: Certification Regarding Lobbying Certification For Contracts, Grants,
Loans and Cooperative Agreements

Exhibit J: Certification Regarding Health Insurance Portability and Accountability
Access Act of 1996 Compliance

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 4 of 44

AGREEMENT TO PROVIDE

COMPREHENSIVE HEALTH CARE SERVICES

This Agreement is made by and between the Florida Healthy Kids Corporation, hereinafter
referred to as “FHKC” and HEALTHEASE OF FLORIDA, INC. AND WELL CARE HMO, INC. hereinafter
collectively referred to as “INSURER.”

WHEREAS, FHKC has been specifically empowered in section 624.91 (5)(b)(10), Florida Statutes,
to enter into contracts with Health Maintenance Organization (HMO’s), insurers, or any provider of
health care services hereinafter referred to as “Insurer,” meeting standards established by FHKC,
for the provision of comprehensive health insurance coverage to Participants; and

WHEREAS, Sections 641.2017 (1) and (2), Florida Statutes, allows INSURER to enter such a
contractual arrangement on a prepaid per capita basis whereby INSURER assumes the risk that costs
exceed the amount paid on a prepaid per capita basis; and

WHEREAS, FHKC desires to increase access to health care services and improve children’s
health;

and

WHEREAS, FHKC did issue a Request for Proposals (“RFP”) in FHKC Health Insurance Program
inviting INSURER as well as other entities, to submit a proposal for the provision of those
Comprehensive Health Care Services set forth in the Request for Proposals; and

WHEREAS, insurer’s proposal in response to the Request for Proposals was selected
through a competitive bid process as one of the most responsive and cost effective bids; and

WHEREAS, INSURER has assured FHKC of full compliance with the standards established in this
Agreement and agrees to promptly respond to any required revisions or changes in FHKC operating
procedures or benefits which may be required by law or implementing regulations; and

WHEREAS, INSURER agrees that the Request for Proposals released by FHKC and insurer’s
response to that RFP are incorporated by reference and in any conflict between the RFP or the
insurer’s response to the RFP and this Agreement, the Agreement shall control; and

WHEREAS, FHKC is desirous of using insurer’s provider network to deliver
Comprehensive Health Care Services to all eligible FHKC Participants in counties covered under
Exhibit A of this Agreement;

NOW, THEREFORE, in consideration of the premises and the mutual covenants and promises
contained herein, the parties agree as follows:

SECTION 1 GENERAL PROVISIONS

1-1 Definitions

As used in this Agreement, the term:

	 	A.	 	“Comprehensive Health Care Services” means those
services, medical equipment, and supplies to be provided by INSURER in
accordance with standards set by FHKC and further described in Exhibit C.

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 5 of 44

	 	B.	 	“Program” shall mean the project established by FHKC pursuant
to Section 624.91, Florida Statutes.

	 	C.	 	“Participant” or “Enrollee” means those
individuals meeting FHKC standards of eligibility and who have been
enrolled in the Program.

D. “Insurer Providers” shall mean those providers set forth in the
Insurer’s

Response to the Request for Proposals and the Participant’s handbook
as from time to time amended.

	 	E.	 	“Co-Payment” or “Cost Sharing” is the
payment required of the Participant at the time of obtaining service. In
the event the Participant fails to pay the required Co-Payment, INSURER
may decline to provide non-emergency or non-urgently needed care unless
the Participant meets the conditions for waiver of Co-Payments described
in Exhibit C.

F. “Fraud” shall mean:

1) Any FHKC Participant or person who knowingly:

	 	a)	 	Fails,
by any false statement, misrepresentation,

impersonation, or other fraudulent means, to disclose
a material fact used in making a determination as to
such person’s qualification to receive Comprehensive
Health Care Services coverage under the FHKC Program;

	 	b)	 	Fails to
disclose a change in circumstances in order to obtain or
continue to receive Comprehensive Health Care Services
coverage under the FHKC Program to which he or she is
not entitled or in an amount larger than that which he
or she is entitled;

	 	c)	 	Aids and
abets another person in the commission of any such act.

2) Any person or FHKC Participant who:

	 	 	 	a)
Uses, transfers, acquires, traffics, alters,
forges, or possesses, or

	 	 	 	b)
Attempts to use, transfer, acquire, traffic,
alter, forge or possess, or

	 	 	 	c)
Aids and abets another person in the use,
transfer, acquisition, traffic, alteration,
forgery or possession of an FHKC identification
card.

	 	G.	 	“State Children’s Health Insurance Program
(SCHEP)” or “Title XXI” shall mean the program created by the federal
Balanced Budget Act of 1997 as Title XXI of the Social Security Act.

H. “Children’s Medical Services Network” or “CMS” shall mean the
statewide

managed care system which includes health care providers, as defined in
Section

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 6 of 44

391.021(1), Florida Statutes, which is funded by Title XXI.
“Children’s Medical Services Network” or “CMS” as used under this
Agreement does not include any additional programs and services
provided by or through the Children’s Medical Services Program
described in Sections 391.021(8) and 391.025, Florida Statutes, which
are not provided through the Children’s Medical Services network or
which are not funded by Title XXI (such as the CMS Safety Net
Program).

	 	I.	 	“Florida Statutes” shall mean the 2004
Florida Statutes, as amended from time to time by the Florida
Legislature, during the term of this Agreement.

SECTION 2 FLORIDA HEALTHY KIDS CORPORATION RESPONSIBILITIES

2-1 Participant Identification

FHKC shall promptly furnish to INSURER information to sufficiently identify Participants in the
Comprehensive Health Care Services plan authorized by this Agreement.

Additionally, FHKC shall provide INSURER a compatible computer tape, or other computer-ready media
as agreed upon by the Parties, with the names of Participants along with monthly additions or
deletions throughout the term of this Agreement in accordance with the following:

	 	A.	 	Not less than seven (7) working days prior to the effective date
of coverage, FHKC shall provide INSURER a listing of Participants eligible for
coverage. Such listing will also identify those Participants whose coverage shall
terminate on the last day of the current coverage month.

B. By the third (3rd) day after the effective date of coverage, FHKC
shall also furnish

INSURER a supplemental list of eligible Participants for that coverage month.
INSURER shall adjust enrollment retroactively to the 1st day of that month.

D. FHKC may request INSURER to accept additional Participants after the
supplemental

listing for enrollment retroactive to the 1st of that coverage month.
Such additions will be limited to those Participants who made timely payments but
were not included on the previous enrollment reports. If such additions exceed more
than one percent (1%) on that month’s enrollment, INSURER reserves the right to
deny FHKC’s request.

2-2 Payments

FHKC will promptly forward the authorized premiums in accordance with Exhibit A attached hereto and
incorporated herein as part of this Agreement on or before the 1st day of each month this Agreement
is in force commencing with the 1st day of October, 2005. Premiums are past due on the 15th day of
each month.

In the case of non-payment of premiums by the 15th day of the month for that month of coverage,
INSURER shall have the right to terminate coverage under this Agreement, provided FHKC is given
written notice prior to such termination, see Section 4-13. Termination of coverage shall be
retroactive to the last day for which premium payment has been made.

2-3 Reduced Fee Arrangements

2-3-1 Specialty Service Fee Arrangements

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 7 of 44

Upon prior approval of INSURER, FHKC shall have the right to negotiate
specialty service fee arrangements with non-INSURER affiliated providers and make
such rates available to INSURER. In such cases, if there is a material impact on
the premium, the premium in Exhibit A will be adjusted by INSURER in a manner
consistent with sound actuarial practices.

2-3-2 Children’s Medical Services Network

If there is a material impact on the premium in Exhibit A due to the
implementation of the Children’s Medical Services Network as created in Chapter
391, Florida Statutes, INSURER agrees to reduce the premium in Exhibit A in an
amount consistent with sound actuarial practices.

2-4 Program Updates

FHKC shall provide INSURER with updates on Program highlights such as Participant demographics,
profiles, newsletters, legislative or regulatory inquiries and Program directives.

2-5 Change in Benefit Schedule

INSURER understands that changes in federal and state law may require amendments to the Participant
benefit schedule as set forth in Exhibit C. Should such changes be necessary, FHKC shall notify
INSURER in writing of the required change and INSURER shall have thirty (30) days to agree to the
amended benefits schedule. If INSURER elects not to implement a change in the benefit schedule,
FHKC may terminate this Agreement by providing INSURER with a written notice of termination and
include a termination date of not less than ninety (90) days from date of the written notification.

If the change in the benefit schedule results in a reduction in a benefit level, INSURER shall
reduce its premium rate by an amount actuarially equivalent to the benefit reduction. INSURER must
provide an actuarial memorandum to FHKC indicating the actuarial value of the benefit reduction.

2-6 Marketing

FHKC will market the Program primarily through the county school districts. FHKC agrees that
INSURER shall be allowed to participate in any scheduled marketing efforts to include, but not be
limited to, any scheduled open house type activities. However, INSURER is prohibited from any
direct marketing to applicants or Enrollees. INSURER may not utilize FHKC’s logo, name, or
corporate identity, unless such activity or promotion has received prior written authorization from
FHKC. Written authorization must be received for every individual activity.

FHKC will have the right of approval or disapproval of all descriptive plan literature
and forms. 2-7 Forms and Reports

FHKC agrees that INSURER shall participate in the development of any FHKC eligibility report
formats that may be required from time to time.

2-8 Coordination of Benefits

FHKC agrees that INSURER may coordinate health benefits with other Insurers as provided for in
Section 624.9 l(5)(c), Florida Statutes, and Exhibit D of this Agreement. INSURER also agrees to
coordinate benefits with any Insurer under contract with FHKC to provide comprehensive dental
benefits to FHKC Participants, including

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Page 8 of 44

providing prescription coverage prescribed by the Enrollee’s dental provider.

If INSURER identifies a Participant covered through another health benefits program, INSURER shall
notify FHKC. FHKC shall decide whether the Participant may continue coverage through FHKC in
accordance with the eligibility standards adopted by FHKC and in accordance with any applicable
state laws.

2-9 Entitlement to Reimbursement

In the event INSURER provides medical services or benefits to Participants who suffer injury,
disease or illness by virtue of the negligent act or omission of a third party, INSURER shall be
entitled to reimbursement from the Participant, at the prevailing rate, for the reasonable value of
the services or benefits provided. INSURER shall not be entitled to reimbursement in excess of the
Participant’s monetary recovery for medical expenses provided from the third party. INSURER is
solely responsible for the coordination of benefits with any other third party payor in accordance
with Section 624.91(5)(c), Florida Statutes.

SECTION 3 INSURER RESPONSIBILITIES

3-1 Benefits

INSURER agrees to make its provider network available to FHKC Participants in the counties listed
in Exhibit A and to provide the Comprehensive Health Care Services as set forth in Exhibit C
attached hereto and by reference made a part hereof.

3-2 Access to Care

3-2-1 Access and Appointment Standards

INSURER agrees to meet or exceed the appointment and geographic access standards for
pediatric care existing in the community and as specifically provided for in Exhibit E
attached hereto and incorporated herein as a part of this Agreement.

In the event insurer’s provider network is unable to provide those medically
necessary benefits specified in Exhibit C under the standards established in Exhibit E, for
any reason except force majeure, INSURER shall be responsible for those contract benefits
obtained from providers other than INSURER for eligible FHKC Participants.

In the event INSURER fails to meet those access and appointment standards set forth in
Exhibit E, FHKC shall notify INSURER of its noncompliance with the standards in Exhibit E. If
the noncompliance is not corrected within, the time standards established in Exhibit E, FHKC
may direct its Participants to obtain such contract benefit from other willing and qualified
providers and may contract for such services. All financial responsibility related to
services received under these specific circumstances shall be assumed by INSURER.

3-2-2 Integrity of Professional Advice to Enrollees

INSURER ensures no interference with the advice of health care professionals to Enrollees and
that information about treatments will be provided to Enrollees and their families in the
appropriate manner.

INSURER agrees to comply with any federal regulations related to physician incentive plans
and any disclosure requirements related to such incentive plans.

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Page 9 of 44

3-3 Fraud and Abuse

INSURER ensures that it has appropriate measures in place to ensure against fraud and abuse.
INSURER shall report to FHKC any information on violations by subcontractors or Participants that
pertains to enrollment or the payment and provision of health care services under this Agreement.

INSURER agrees to allow FHKC access to monitor any fraud and abuse prevention activities
conducted by INSURER under this Agreement.

Applicants and Enrollees who are found no longer to be eligible, have submitted incorrect or
fraudulent information or failed to submit required information for eligibility determination, may
be disenrolled immediately from the Program by FHKC. Individuals who knowingly provided false
information in order to obtain benefits under the Healthy Kids or Florida KidCare Program may be
subject to prosecution under Section 414.39, Florida Statutes. Should the INSURER become aware of
any such activity, the INSURER shall report its findings to FHKC for investigation.

3-4 Membership Materials

INSURER agrees that it shall not utilize the marketing materials, logos, trade names, service
marks or other materials belonging to FHKC, without FHKC’s consent that shall not be
unreasonably withheld.

INSURER shall be responsible for all preparation, cost and distribution of member handbooks, plan
documents, materials, and orientation, for FHKC Participants. Materials will be appropriate to the
population served and unique to the Program. All membership materials and documents which are
distributed to FHKC Participants must be reviewed and approved by FHKC prior to distribution.

INSURER agrees to provide FHKC with a copy of all such documents for review on an annual
basis. 3-5 Use of Name

INSURER consents to the use of its name in any marketing and advertising or media presentations
describing FHKC which are developed and disseminated by FHKC to Participants, employees, employers,
the general public or the County School System, provided however, INSURER reserves the right to
review and concur in any such marketing materials prior to its dissemination.

3-6 Eligibility

INSURER agrees to accept those Participants which FHKC has determined meet the Program’s
eligibility requirements.

3-6-1 Requests for Eligibility Review

INSURER reserves the right to request that FHKC review the eligibility of a particular
Enrollee. FHKC shall ensure all records and findings maintained by FHKC concerning a
particular eligibility determination will be made available with reasonable promptness to
the extent permitted under Section 624.91, Florida Statutes,_and Section 409.821, Florida
Statutes, regarding confidentiality of information held by FHKC and the Florida KidCare
Program.

3-6-2 Eligibility Review Process

If the INSURER and FHKC dispute whether a Participant is eligible for the Program
because the INSURER believes that the Participant should be, or is, enrolled in CMS,
then upon receipt of a

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Page 10 of 44

$100.00 fee, INSURER may request that FHKC seek an independent determination ofCMS
eligibility from the Florida Department of Health and, if appropriate, the Florida
Department of Children and Families. Both the INSURER and FHKC agree that the decision of
the Florida Department of Health and if applicable, the Florida Department of Children
and Families regarding the Participant’s eligibility for CMS shall be final and binding.

If a Participant is determined not to be eligible for the FHKC Program, and the INSURER
included that Participant in supporting actuarial memoranda to support a premium or rate
modification request under section 3-17,1. of this Agreement, then the INSURER shall
submit to FHKC a revised supporting actuarial memorandum which excludes that Participant.
Thereafter, the INSURER’S premium or rate shall be reviewed by the Board of Directors of
FHKC and adjusted accordingly. The INSURER and FHKC agree that the rights and remedies
provided under this Section 3-6 shall be exclusive as to eligibility disputes

3-7 Effective Date of Coverage

Coverage for every Participant shall become effective at 12:01 a.m. EST/EDT, on the first day of
the Participant’s first coverage month, as determined by FHKC.

3-8 Termination of Participation A Participant’s coverage under this Program shall terminate on
the last day of the month in which the Participant:

A. ceases to be eligible to participate in the Program;

B. establishes residence outside the service area; or

C. is determined to have acted fraudulently pursuant to Section l-l(F) or Section
3-3. Termination of coverage and the effective date of that termination shall be determined
solely by FHKC.

3-9 Continuation of Coverage Upon Termination of this Agreement

INSURER agrees that, upon termination of this Agreement for any reason, unless instructed otherwise
by FHKC, it will continue to provide inpatient services to FHKC Participants who are then
inpatients until such time as such Participants have been appropriately discharged. However,
INSURER shall not be required to provide such extended benefits beyond twelve (12) calendar months
from the date the Agreement is terminated.

If INSURER terminates this Agreement at its sole option and through no fault of FHKC, and if on the
date of termination a Participant is totally disabled and such disability commenced while coverage
was in effect, that Participant shall continue to receive all benefits otherwise available under
this Agreement for the condition under treatment which caused such total disability until the
earlier of (1) the expiration of the contract benefit period for such benefits; (2) determination
by the Medical Director of INSURER that treatment is no longer medically necessary; (3) twelve (12)
months from the date of termination of coverage; (4) a succeeding carrier elects to provide
replacement coverage without limitation as to the disability condition; provided however, that
benefits will be provided only so long as the Participant is continuously totally disabled and only
for the illness or injury which caused the total disability.

For purposes of this section, a Participant who is “totally disabled” shall mean a Participant who
is physically unable to work, as determined by the Medical Director of INSURER, due to an illness
or injury at any gainful job for which the Participant is suited by education, training, experience
or ability. Pregnancy, childbirth or hospitalization in and of itself do not constitute “total
disability.” In the case of maternity coverage, when a

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Page 11 of 44

Participant is eligible for such coverage and when not covered by a succeeding carrier, a
reasonable period of extension of benefits shall be granted. The extension of benefits shall be
only for the period of pregnancy and shall not be based on total disability.

3-10 Participant Certificates and Handbooks

INSURER will issue Participant certificates, identification cards, provider network listings and
handbooks to all FHKC designated Participants within five (5) business days of receipt of an
eligibility tape. Except as specifically provided in Sections 3-8 and 3-12 hereof, all Participant
rights and benefits shall terminate upon termination of this Agreement or upon termination of
participation in the Program. All Participant handbooks and member materials must be approved by
FHKC prior to distribution.

3-11 Refusal of Coverage

INSURER shall not refuse to provide coverage to any Participant on the basis of past or present
health status.

3-12 Extended Coverage

With regards to those Participants who have been terminated pursuant to Section 3-7 A, INSURER
agrees to offer individual coverage to all Participants without regard to health condition or
status.

3-13 Grievances and Complaints

INSURER agrees to provide all FHKC Participants a Grievance Process. The grievance and complaint
procedures shall be governed by any applicable federal and state laws and regulations issued for
SCHIP, and the following additional rules and guidelines also apply:

	 	A.	 	There must be sufficient support staff (clerical and
professional) available to process grievances.	 

	 	B.	 	Staff must be educated concerning the importance of the procedure
and the rights of the Enrollee.

C. Someone with problem solving authority must be part of the grievance
procedure.

D. In order to initiate the grievance process, such grievance must be filed
in writing.

	 	E.	 	The parties will provide assistance to grievant during the
grievance process to the extent FHKC deems necessary.

	 	F.	 	Grievances shall be resolved within sixty (60) days from initial
filing by the Participant, unless information must be collected from providers
located outside the authorized service area or from non-contract providers. In such
exceptions, an additional extension shall be authorized upon establishing good
cause.

	 	G.	 	A record of informal complaints received that are not grievances
shall be maintained and shall include the date, name, nature of the complaint and
the disposition.

	 	H.	 	The grievance procedures must conform to the federal
regulations governing the State Children’s Health Insurance Program (SCHEP).	 

I. A quarterly report of all grievances involving FHKC Participants must be
submitted to

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FHKC. The report shall list the number of grievances received during the
quarter and the disposition of those grievances. INSURER shall also inform FHKC of
any grievances that are referred to the Statewide Subscriber Assistance Panel or
its successor(s) prior to their presentation at the panel.

	 	J.	 	The INSURER shall provide FHKC with its current grievance process
for FHKC Participants upon execution of this Agreement and then annually thereafter.
Additionally, INSURER shall provide FHKC with advance notice of any subsequent
changes to the process. Such changes must be reviewed and approved by FHKC prior to
implementation.

3-14 Claims Payment

INSURER will pay any claims from its offices located at 8735 Henderson Road, Tampa, Florida 33634
(or any other designated claims office located in its service area). INSURER will pay clean claims
filed within thirty (30) working days or request additional information of the claimant necessary
to process the claim.

3-15 Notification Requirements

A. INSURER shall immediately notify FHKC in writing of:

	 	1.	 	Any judgment, decree, or order rendered by
any court of any jurisdiction or

Florida Administrative Agency enjoining INSURER from the sale or
provision of service under Chapter 641, Part II, Florida Statutes.

	 	2.	 	Any petition by INSURER in bankruptcy or
for approval of a plan of

reorganization or arrangement under the Bankruptcy Act or Chapter 631,
Part I, Florida Statutes, or an admission seeking the relief provided
therein.

	 	3.	 	Any petition or order of rehabilitation or
liquidation as provided in Chapters 631 or 641, Florida Statutes.

	 	4.	 	Any order revoking the INSURER’S
Certificate of Authority.

	 	5.	 	Any administrative action taken by the
Department of Financial Services or

Office of Insurance Regulation_or the Agency for Health Care
Administration in regard to INSURER.

	 	6.	 	Any medical malpractice action filed in a
court of law in which a FHKC

Participant is a party (or in whose behalf a Participant’s
allegations are to be litigated).

	 	7.	 	The filing of an application for change of
ownership with the Florida Department of Financial Services or Office
of Insurance Regulation.

	 	8.	 	Any change in subcontractors who are
providing services to FHKC Participants in accordance with the
provisions of Section 3-31 of this Agreement.

	 	9.	 	Any pending litigation or commencement of
legal action involving the

INSURER in which liability for or the insurer’s
obligation to pay could exceed 10% of the insurer’s
surplus.

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Page 13 of 44

B. Monthly Notification Requirements

INSURER shall inform FHKC monthly of any changes to the provider network that
differ from the network presented in the original bid proposal, including
discontinuation of any primary care providers or physician practice associations
or groups with Healthy Kids Enrollees on its panels. FHKC may require INSURER to
provide PHKC with evidence that its provider network continues to meet the
appointment and access standards described in Exhibit E.

3-16 Rates

The rate charged for provision of Comprehensive Health Care Services shall be as stated in Exhibit
A.

3-17 Rate Modification

I. Annual Adjustment

Upon request by INSURER, the Board of Directors of FHKC may approve an adjustment
to the premium effective only on October 1st of each contract year;
however each adjustment request must meet the following minimum conditions:

A. Any request to adjust the premium must be received by the preceding April
1;

	 	B.	 	The request for an adjustment must be accompanied by a
supporting actuarial memorandum; and

C. The proposed premium shall not be excessive or inadequate in accordance

with the standards established by the Department of Financial Services or the
Office of Insurance Regulation for such determination.

II. Rate Adjustment Denials

In the event that the insurer’s rate adjustment is denied by the
Board of Directors of FHKC, the INSURER may request that an independent
actuary be retained to determine whether or not the proposed rate is
excessive or inadequate.

A. Any request for a review of a denied rate must be submitted by the

INSURER to FHKC in writing within fourteen (14) calendar days of the date of
the board meeting in which the Board of Directors denied the rate request.

B. The INSURER must provide FHKC with a list of three (3) qualified

independent actuaries and also provide the curriculum vitae for each

proposed actuary. FHKC shall select an actuary from the list provided by the

INSURER no later than fourteen (14) calendar days following receipt of the

information from INSURER.

C. The actuary’s findings must be in writing and communicated to both FHKC

and the INSURER within thirty (30) days after execution of the Letter of the

Engagement by all parties.

D. The effective date of the actuary’s determination shall be October
1st or the

first of the month following the receipt of the actuary’s findings, whichever

occurs later.

E. The cost for such review will be split between FHKC and INSURER.

F. The decision of the independent actuary will be binding on FHKC and

	 	 	 	 	 	 	 	 	 
	HEALTHEASE AND STAYWELL HMO
	 	 	 	 	 	Effective Date: October 1, 2005
	 
	 	 	 	 	 	 	 	 
	3-18

	 	Conditions of Services
	 	INSURER.

	 	Page 14 of 44

	 	

Services shall be provided by INSURER under the following conditions:

	 	A.	 	Appointment. Participants shall first contact their
assigned primary care physician for an appointment in order to receive non-emergency
health services.

	 	B.	 	Provision of Services. Services shall be provided and
paid for by INSURER only when INSURER performs, prescribes, arranges or authorizes
the services. Services are available only from and under the direction of INSURER
and neither INSURER nor INSURER physicians shall have any liability or obligation
whatsoever on account of any service or benefit sought or received by any member
from any other physician or other person, institution or organization, unless prior
special arrangements are made by INSURER and confirmed in writing except as provided
for in Section 3-2.

C. Hospitalization. INSURER does not guarantee the admission of a
Participant to any

specific hospital or other facility or the availability of any accommodations or
services therein. Inpatient Hospital Service is subject to all rules and
regulations of the hospital or other medical facility to which the Participant is
admitted.

D. Emergency Services. Exceptions to Section 3-18 A, B and C are services
which are

needed immediately for treatment of an injury or sudden illness wherein delay
means risk of permanent damage to the Participant’s health. INSURER shall provide
and pay for emergency services both inside and outside the service area.

3-19 Medical Records Requirements

INSURER shall require providers to maintain medical records for each Participant under this
Agreement in accordance with applicable state and federal law.

3-19-1 Medical Quality Review and Audit

FHKC shall conduct an independent medical quality review of INSURER during this
Agreement term. The independent auditor’s report will include a written review
and evaluation of care provided to FHKC Participants in the county. Additional
reviews also may be conducted after completion of the baseline review at the
discretion of FHKC. INSURER agrees to cooperate in all evaluation efforts
conducted or authorized by FHKC.

3-19-2 Privacy of Medical Records

INSURER will ensure that all individual medical records will be maintained with
confidentiality in accordance with state and federal guidelines. INSURER agrees
to abide by all applicable state and federal laws governing the confidentiality
of minors and the privacy of individually identifiable health information.
insurer’s policies and procedures for handling medical records and
protected health information (PHI) shall be compliant with the Health Insurance
Portability and Accountability Act of 1996 (HIPAA) and shall include provisions
for when an Enrollee’ s PHI may be disclosed without consent or authorization.

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3-19-3 Requests by Participants for Medical Records

INSURER will ensure that each Participant may request and receive a copy of
records and information pertaining to that Enrollee in a timely manner.
Additionally, the Participant may request that such records be corrected or
supplemented.

3-20 Quality Enhancement (Assurance)

The INSURER shall have a quality enhancement program. If the INSURER has an existing program, it
must satisfy FHKC’s quality enhancement standards. Approval will be based on the insurer’s
adherence to the minimum standards listed below.

	 	 	 	3-20-1 Quality Enhancement Authority. The plan shall have a quality
enhancement review authority that shall:	 

(a) Direct and review all quality enhancement activities.

(b) Assure that quality enhancement activities take place in all
areas of the plan.

(c) Review and suggest new or improved quality enhancement activities.

(d) Direct task forces/committees in the review of focused concern.

(e) Designate evaluation and study design procedures.

(f) Publicize findings to appropriate staff and departments within
the plan.

(g) Report findings and recommendations to the appropriate executive
authority.

(h) Direct and analyze periodic reviews of Enrollees’ service
utilization patterns.

	 	 	 	3-20-2 Quality Enhancement Staff. The plan shall provide for quality
enhancement staff which has the responsibility of:

	 	(a)	 	Working with personnel in each clinical
and administrative department to identify problems related to quality
of care for all covered professional services.

	 	(b)	 	Prioritizing problem areas for
resolution and designing strategies for change.

	 	(c)	 	Implementing improvement activities and
measuring success.

	 	(d)	 	Providing outcome of any Quality
Enhancement activities involving children 5-19 years of age to FHKC.

	 	 	 	3-20-3 Peer Review Authority. The plan’s quality enhancement program
shall have a peer review component and a Peer Review Authority.	 

Scope of Activities

	 	(a)	 	The review of the practice methods and patterns
of individual physicians and other health care professionals.

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Page 16 of 44

	 	(b)	 	The ability and responsibility to
evaluate the appropriateness of care rendered by professionals.

(c) The authority to implement corrective action when deemed necessary.

	 	(d)	 	The responsibility to develop policy
recommendations to maintain or enhance the quality of care provided to
plan Participants.

(e) A review process which includes the appropriateness of diagnosis and

subsequent treatment, maintenance of medical record requirements,
adherence to standards generally accepted by professional group peers,
and the process and outcome of care.

	 	(f)	 	The maintenance of written minutes of the
meetings and provision of reports to FHKC of any activities related to
FHKC Participants.

(g) Peer review must include examination of morbidity and mortality.

	 	 	 	3-20-4 Referrals To Peer Review Authority	 

	 	(a)	 	All written and/or oral allegations of
inappropriate or aberrant service must be referred to the Peer Review
Authority.

	 	(b)	 	Recipients and staff must be advised of
the role of the Peer Review Authority and the process to advise the
Authority of situations or problems.

	 	(c)	 	All grievances related to medical
treatment must be presented to the Authority for examination and when a
FHKC Participant is involved, the outcome of the grievance resolution
reported to FHKC.

3-21 Availability of Records

INSURER shall make all records available at its own expense for review, audit, or evaluation by
authorized federal, state and FHKC personnel. The location will be determined by INSURER subject to
approval of FHKC. Access will be during normal business hours and will be either through on-site
review of records or through the mail.

Copies of all records will be sent to FHKC by certified mail within seven (7) working days of
request. It is FHKC’s responsibility to obtain sufficient authority, as provided for by
applicable statute or requirement, to provide for the release of any patient specific
information or records requested by FHKC, state or federal agencies.

3-22 Audits

3-22-1 Accessibility of Records

INSURER shall maintain books, records, documents, and other evidence pertaining
to the administrative costs and expenses of this Agreement. These records,
books, documents, and any related financial transactions shall be available for
review by authorized federal, state and FHKC personnel during the Agreement
period and for up to five (5) years thereafter, except if an audit is in
progress or audit findings are yet unresolved in which

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 17 of 44

case records shall be kept until all tasks are completed. Such terms and
conditions shall also be required of any subcontractors who perform any
duties under this Agreement. INSURER will ensure that such terms are included
in any subcontracts or other agreements with affiliated entities that may
perform duties or provide services under this Agreement on the insurer’s
behalf.

During the Agreement period, these records shall be available at
insurer’s offices at all reasonable times. After the Agreement
period and for five (5) years following, the records shall be available upon
reasonable notice at the insurer’s chosen location subject to the
approval of FHKC. If the records need to be sent to FHKC, INSURER shall bear
the expense of delivery. Prior approval of the disposition of INSURER and
subcontractor records must be requested and approved if the contract or
subcontract is continuous.

This Agreement is subject to unilateral cancellation by FHKC if INSURER
refuses to allow such public access or fails to ensure such access to the
records of its subcontractors or affiliates who may perform duties or
services under this Agreement.

3-22-2 Financial Audit

Upon reasonable notice by FHKC, INSURER shall permit an independent audit by
FHKC of its financial condition or performance standard in accordance with
the provisions of this Agreement and the Florida Insurance Code and
regulations adopted thereunder.

Additionally, INSURER agrees annually to provide an audited financial
statement to FHKC by July 1 of each year for the insurer’s preceding
fiscal year.

3-22-3 Post-Agreement Audit

INSURER shall cooperate with any post-Agreement audits conducted by FHKC, an
independent entity under contract with FHKC or any other appropriate state or
federal regulatory authority. Such audits shall include a review of the
insurer’s administrative costs and expenses with regard to the
Program and Program funds. This provision shall also be included in any
agreement between INSURER and its subcontractors or affiliates in order to
ensure access to any related financial transactions with regard to the
Program or Program funds.

In addition, INSURER agrees to the following:

INSURER agrees to retain and make available upon request to FHKC, any entity
contracted with FHKC or a state or federal regulatory agency, all books,
documents and records necessary to verify the nature and extent of the costs
of the services provided under this Agreement, and that such records will be
retained and held available by INSURER for such inspection until the
expiration of five (5) years after the services are furnished under this
Agreement.

If, pursuant to this Agreement and if insurer’s duties and
obligations are to be carried out by an individual or entity subcontracting
with INSURER and that subcontractor, to a significant extent, owns or is
owned by or has control of or is controlled by INSURER, each subcontractor
shall itself be subject to the access requirement and INSURER hereby agrees
to require such subcontractors to meet the access requirement both during and

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Page 18 of 44

after the Agreement term.

INSURER understands that any request for access must be in writing and
contain reasonable identification of the documents, along with a statement as
to the reason that the appropriateness of the costs or value of the services
in question cannot be adequately or efficiently determined without access to
its books or records. INSURER agrees that it will notify FHKC in writing
within ten (10) days upon receipt of a request for access.

3-22-4 Accessibility for Monitoring

INSURER shall make available to all authorized federal, state and FHKC
personnel, records, books, documents, and other evidence pertaining to this
Agreement as well as appropriate personnel for the purpose of monitoring
under this Agreement. The monitoring shall occur periodically during this
Agreement period.

INSURER also agrees to cooperate in any evaluative efforts conducted by FHKC
or an authorized subcontractor of FHKC both during and after the term of this
Agreement for a period up to five (5) years.

3-23 Indemnification

INSURER agrees to indemnify and hold harmless FHKC from any losses resulting from negligent,
dishonest, fraudulent or criminal acts of INSURER, its officers, its directors, or its employees,
whether acting alone or in collusion with others.

INSURER shall indemnify, defend, and hold FHKC and its officers, employees and agents harmless from
all claims, suits, judgments or damages, including court costs and attorney fees, arising out of
any negligent or intentional torts by INSURER.

INSURER shall hold all enrolled Participants harmless from all claims for payment of covered
services, except Co-Payments, including court costs and attorney fees arising out of or in the
course of this Agreement pertaining to covered services. In no case will FHKC or Program
Participants be liable for any debts of the INSURER.

INSURER agrees to indemnify, defend, and save harmless FHKC, its officers, agents, and employees
from:

	 	A.	 	Any claims or losses attributable to a service rendered by any
subcontractor, person, or firm performing or supplying services, materials, or
supplies in connection with the performance of this Agreement regardless of whether
FHKC knew or should have known of such improper service, performance, materials or
supplies.

	 	B.	 	Any failure of INSURER, its officers, employees, or
subcontractors to observe Florida law, including but not limited to labor laws and
minimum wage laws, regardless of whether FHKC knew or should have known of such
failure.

With respect to the rights of indemnification given herein, INSURER agrees to provide to FHKC, if
known to INSURER, timely written notice of any loss or claim and the opportunity to mitigate,
defend and settle such loss or claim as a condition of indemnification. With respect to the rights
of indemnification given herein, FHKC agrees to provide to INSURER, if known to FHKC, timely
written notice of any loss or claim and the opportunity to mitigate, defend and settle such loss or
claim as a condition to indemnification

	 	 	 
	3-24Confidentiality of Information

	 	

	 
	 	 
	HEALTHEASE AND STAYWELL HMO

	 	Effective Date: October 1, 2005

Page 19 of 44

INSURER shall treat all information, and in particular information relating to Participants
that is obtained by or through its performance under this Agreement, as confidential information to
the extent confidential treatment is provided under state and federal laws. INSURER shall not use
any information so obtained in any manner except as necessary for the proper discharge of its
obligations and to secure its rights under this Agreement.

All information as to personal facts and circumstances concerning Participants obtained by INSURER
shall be treated as privileged communications, shall be held confidential, and shall not be
divulged without the written consent ofFHKC, the Participant’s parent or guardian or the
Participant, provided that nothing stated herein shall prohibit the disclosure of information in
summary, statistical, or other form which does not identify particular individuals. The use or
disclosure of information concerning Participants will be limited to purposes directly connected
with the administration of this Agreement. It is expressly understood that substantial evidence of
insurer’s refusal to comply with this provision shall constitute a breach of this
Agreement.

3-25 Insurance

INSURER shall not commit any work in connection with this Agreement until it has obtained all types
and levels of insurance required and approved by appropriate state regulatory agencies. The
insurance includes but is not limited to workers’ compensation, liability, fire insurance, and
property insurance. Upon request, FHKC shall be provided proof of coverage of insurance by a
certificate of insurance accompanying the contract documents.

FHKC shall be exempt from and in no way liable for any sums of money that may represent a
deductible in any insurance policy. The payment of such a deductible shall be the sole
responsibility of INSURER and/or subcontractor holding such insurance. The same holds true of any
premiums paid on any insurance policy pursuant to this Agreement. Failure to provide proof of
coverage may result in this Agreement being terminated.

3-26 Lobbying Disclosure

INSURER shall comply with applicable state and federal requirements for the disclosure of
information regarding lobbying activities of the firm, subcontractors or any authorized agent.
Certification forms shall be filed by INSURER certifying that no state or federal funds have been
or will be used in lobbying activities, and the disclosure forms shall be used by INSURER to
disclose lobbying activities in connection with the program that have been or will be paid with
non-federal funds.

3-27 Reporting Requirements

INSURER agrees to provide on a timely basis the quarterly statistical reports detailed in Exhibit G
to FHKC that FHKC must have to satisfy reporting requirements. INSURER also agrees to attest to the
accuracy, completeness and truthfulness of claims and payment data that are submitted to FHKC under
penalty of perjury. Access to Participant claims data by FHKC, the State of Florida, the federal
Centers for Medicare and Medicaid Services, and the Department of Health and Human Services
Inspector General will be allowed to the extent allowed under any state privacy protections.

Failure to provide the reports required under Exhibit G may be cause for termination under Section
4-13(A) of this Agreement.

3-28 Participant Liability

INSURER hereby agrees that no FHKC Participant shall be liable to INSURER or any INSURER network
providers for any services covered by FHKC under this Agreement. Neither INSURER nor any
representative of INSURER shall collect or attempt to collect from an FHKC Participant any money
for services covered by the Program and neither INSURER nor representatives of INSURER may maintain
any action at law against a FHKC Participant to collect money owed to INSURER by FHKC. FHKC
Participants shall not be liable to INSURER

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 20 of 44

for any services covered by the Participant’s contract with FHKC. This provision shall not
prohibit collection of Co-Payments made in accordance with the terms of this Agreement, nor shall
this provision prohibit collection for services not covered by the contract between FHKC and the
Participants.

3-29 Protection of Proprietary Information

INSURER and FHKC mutually agree to maintain the integrity of all proprietary information, including
but not limited to membership lists, including names, addresses and telephone numbers to the extent
provided under state law. However, INSURER understands that FHKC may be subject to the Florida
Public Records Act, (Section 119.07, Florida Statutes) and all such information may be considered a
public record and open to inspection. To the extent permitted under state law, neither party will
disclose or allow to disclose proprietary information, by any means, to any person without the
prior written approval of the other party. All proprietary information will be so designated.

This requirement does not extend to routine reports and membership disclosure necessary
for efficient management of the Program.

3-30 Regulatory Filings

INSURER will forward all regulatory filings, (i.e., documents, forms and rates) relating to this
Agreement to FHKC for its review and approval. Once such regulatory filings are approved, FHKC will
submit them to the Department of Financial Services on insurer’s behalf.

3-31 Use of Subcontractors or Affiliates

The INSURER may contract with subcontractors or affiliates to deliver services to Participants
under this Agreement subject to the following conditions:

A. INSURER identified the subcontractor or affiliate in its response to the FHKC’s
Request for Proposals for the counties covered by this Agreement;

B. INSURER has provided FHKC with a copy of the current contract or other written
agreement for services between the INSURER and the subcontractor or affiliate and FHKC has approved
the participation of the subcontractor or affiliate and the agreement;

C. insurer’s Agreement with the subcontractor or affiliate fully complies
with all terms and conditions of the Agreement between the INSURER and FHKC;

D. INSURER agrees to notify FHKC in advance of the termination of any subcontractor or
affiliate under this Agreement;

E. INSURER shall provide FHKC with advance notice of the insurer’s intention
to contract with any new subcontractors and affiliates for services covered under this Agreement
and shall forward for FHKC review and approval any agreement for services with the proposed
subcontractors or affiliates;

F. INSURER shall provide FHKC with copies of any amendments or revisions to previously
approved agreements and FHKC shall have the right to withhold its approval of any such amendments;
and,

G. INSURER agrees to provide FHKC with an annual report of all subcontractors or
affiliates that performed services under this Agreement by April 1st of each year for
the most recently concluded calendar year which shall include a copy of all written, executed
contracts with all subcontractors and affiliates.

All agreements between INSURER and its subcontractors or affiliates to provide services to
Participants under this Agreement shall be reduced to writing and shall be executed by both
parties. All such agreements shall also be available to FHKC within seven (7) days of a request for
production.

Failure of INSURER to comply with the provisions of this Section may be considered as grounds
for the termination of this Agreement under Section 4-13 at the discretion of FHKC.

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 21 of 44

SECTION 4 TERMS AND CONDITIONS

4-1 Effective Date

This Agreement shall be effective on the first (1st) day of October 2005 and shall remain in
effect through September 30, 2006.

4-2 Multiple Year Agreement

Parties hereto agree this is a “Multiple Year Agreement,” meaning this Agreement which is effective
as of October 1, 2005 shall extend through September 30, 2006 and shall thereafter be renewed
automatically for no more than two (2) successive one (1) year periods. Either party may elect not
to renew this Agreement and in that event shall give written notice to said effect to the other
party at least one hundred-twenty (120) days prior to the expiration of the then current term.

4-3 Entire Understanding

This Agreement embodies the entire understanding of the parties in relationship to the subject
matter hereof. No other agreement, understanding or representation, verbal or otherwise, relative
to the subject matter hereof exists between the parties at the time of execution of this Agreement.

This Agreement supersedes all prior Agreements between the
parties. 4-4 Relation to Other Laws

4-4-1 Health Insurance Portability and Accountability Act (HIPAA)

Coverage offered under this Agreement is considered creditable coverage for the
purposes of part 7 of subtitle B of title II of ERISA, title XXVII of the Public
Health Services Act and subtitle K of the Internal Revenue Code of 1986. INSURER
is responsible for issuing a certificate of creditable coverage to those FHKC
Participants who disenroll from the Program.

Additionally, INSURER agrees to comply with all other applicable provisions of
the HIPAA, and will certify compliance under Exhibit J.

4-4-2 Mental Health Parity Act (MHPA)

INSURER agrees to comply with the requirements of the Mental Health Parity Act of
1996 regarding parity in the application of annual and lifetime dollar limits to
mental health benefits in accordance with 45 CFR 146.136.

4-4-3 Newboms and Mothers Health Protection Act of 1996 (NMHPA)

INSURER agrees to comply with the requirements of the NMHPA of 1996 regarding
requirements for minimum hospital stays for mothers and newboms in accordance
with 45 CFR 146.130 and 148.170.

	 	 	 	4-5 Independent Contractor

The relationship of INSURER to FHKC shall be solely that of an independent contractor. As an
independent

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 22 of 44

contractor, INSURER agrees to comply with the following provisions:

	 	a.	 	Title VI of the Civil Rights Act of 1964,
as amended, 42 U.S.C. 2000d et seq., which prohibits discrimination on
the basis of race, color, or national origin.

	 	b.	 	Section 504 of the Rehabilitation Act
of 1973, as amended, 29 U.S.C. 794, which prohibits discrimination on
the basis of handicap.	 

	 	c.	 	Title IX of the Education Amendments of
1972, as amended 29 U.S.C. 601 et seq., which prohibits discrimination
on the basis of sex.

	 	d.	 	The Age Discrimination Act of 1975, as
amended, 42 U.S.C. 6101 et seq., which prohibits discrimination on
the basis of age.	 

	 	e.	 	Section 654 of the Omnibus Budget
Reconciliation Act of 1981, as amended, 42 U.S.C. 9848, which prohibits
discrimination on the basis of race, creed, color, national origin, sex,
handicap, political affiliation or beliefs.

	 	f.	 	The Americans with Disabilities Act of
1990, P.L. 101-336, which prohibits discrimination on the basis of
disability and requires reasonable accommodation for persons with
disabilities.

g. Section 274A (e) of the Immigration and Nationalization Act, FHKC
shall

consider the employment by any contractor of unauthorized aliens a
violation of this Act. Such violation shall be cause for unilateral
cancellation of this Agreement.

h. 0MB Circular A-l 10 (Appendix A-4) which identifies procurement

procedures which conform to applicable federal law and regulations with
regard to debarment, suspension, inehgibility, and involuntary
exclusion of contracts and subcontracts and as contained in Exhibit I
of this Agreement. Covered transactions include procurement contracts
for services equal to or in excess of $100,000 and all non-procurement
transactions.

	 	i.	 	The federal regulations implementing the
State Children’s Health Insurance Program (SCHIP) as found in 42 CFR
Parts 431, 433, 435,436 and 457 and any subsequent revisions to the
regulation.

4-6 Assignment

This Agreement may not be assigned by INSURER without the express prior written consent of FHKC.
Any purported assignment shall be deemed null and void.

This Agreement and the monies that may become due hereunder are not assignable by INSURER except
with the prior written approval of FHKC.

4-7 Notice Notice required or permitted under this Agreement
shall be directed as follows:

For INSURER:

TODD FARHA

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 23 of 44

PRESIDENT AND CHIEF EXECUTIVE OFFICER

HEALTHEASE OF FLORIDA, INC.

WELL CARE HMO, INC.

8735 HENDERSON ROAD

RENAISSANCE BLDG 2

TAMPA, FLORIDA 33634

For PHKC:

EXECUTIVE DIRECTOR FLORIDA HEALTHY KIDS
CORPORATION POST OFFICE BOX 980
TALLAHASSEE, FL 32302

or to such other place or person as written notice thereof may be given to the other party.
4-8 Amendment

Not withstanding anything to the contrary contained herein, this Agreement may be amended by mutual
written consent of the parties at any time.

4-9 Governing Law

This Agreement shall be construed and governed in accordance with the laws of the State of Florida.
In the event any action is brought to enforce the provisions of this Agreement, venue shall be in
Leon County, Florida.

4-10 Agreement Variation

If any provision of this Agreement (including items incorporated by reference) is declared or found
to be illegal, unenforceable, or void, then both FHKC and INSURER shall be relieved of all
obligations arising under such provisions. If the remainder of this Agreement is capable of
performance, it shall not be affected by such declaration or finding and shall be fully performed.
In addition, if the laws or regulations governing this Agreement should be amended or judicially
interpreted so as to render the fulfillment of the Agreement impossible or economically infeasible,
both FHKC and INSURER will be discharged from further obligations created under the terms of this
Agreement.

4-11 Attorney Fees

In the event that either party deems it necessary to take legal action to enforce any provision of
this Agreement, the court or hearing officer, in his discretion, may award costs and attorney fees
to the prevailing party. Legal actions are defined to include administrative proceedings.

4-12 Representatives

Each party shall designate a representative serving as the day-to-day management of FHKC Health
Insurance Plan, helping to resolve services questions, assuring proper arbitration in the event of
a dispute, as well as responding to general administrative and procedural problems. These
individuals will be the principal points of contact for all inquiries unless the designated
representatives specifically refer the inquiry to another party within their respective
organizations.

4-13 Termination

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 24 of 44

A. Termination for Cause

FHKC shall have the absolute right to terminate for cause this Agreement, and all obligations
contained hereunder. Cause shall be defined as “any material breach of insurer’s
responsibilities as set forth herein, which cannot be cured by INSURER within 30 days from the
date of written notice from FHKC but, if the default condition cannot be cured within the 30 days,
INSURER may, if it has commenced reasonable efforts to correct the condition within that 30 day
period, have up to 90 days to complete the required cure.” Nothing in this Agreement shall extend
this 90 day period except the mutual consent of the parties hereto.

INSURER shall have the absolute right to terminate for cause this Agreement, and all obligations
contained hereunder. Cause shall be defined as “any material breach of FHKC’s responsibilities as
set forth herein, which cannot be cured by FHKC within 30 days from the date of written notice from
INSURER but, if the default condition cannot be cured within the 30 days, FHKC may, if it has
commenced reasonable efforts to correct the condition within that 30 day period, have up to 90 days
to complete the required cure.” Nothing in this Agreement shall extend this 90 day period except
the mutual consent of the parties hereto.

B. Change of Controlling Interest

FHKC shall have the absolute right to elect to continue or terminate this Agreement, at its sole
discretion, in the event of a change in the ownership or controlling interest of INSURER. INSURER
shall provide notice of regulatory agency approval prior to any transfer or change in control, and
FHKC shall have ten (10) days thereafter to elect continuation or termination of this Agreement.

C. Lack of Funding

FHKC shall the absolute right to terminate this Agreement should state, federal or other funds for
the Program be reduced or terminated such that the Program cannot be sustained at the sole
discretion of FHKC. Should FHKC elect to terminate this Agreement, FHKC shall provide the INSURER a
written notice of termination and include a termination date of not less than thirty (30) days from
the date of the notice.

4-14 Contingency

This Agreement and all obligations created hereunder, are subject to continuation and approval of
funding of FHKC by the appropriate state and federal or local agencies.

IN WITNESS WHEREOF the parties hereto have executed this Agreement on the 28 day of
September 2005.

HEALTHEASE OF FLORIDA, INC.

BY:

	 	 	 
	/s/ Andrea Rosa     

	 	/s/ Todd S. Farha     
	 

	 	 
	Witness

	 	Name: Todd S. Farha

	 	 	 	Title: President and Chief Executive Officer

1

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 25 of 44

WELLCARE HMO, INC.

BY:

	 	 	 	 	 
	/s/ Andrea Rosa______________________	 	/s/ Todd S. Farha________________________

	 
	 	 	 	 
	 	 	 

	 
	 	 	 	 
	Witness

	 	Name: Todd S. Farha
	 	

	 
	 	 	 	 
	 	 	Title: President and Chief Executive Officer

	 
	 	 	 	 
	
 
	 	FLORIDA HEALTHY KIDS CORPORATION

BY:
	 	

	 
	 	 	 	 
	/s/ Jennifer K. Lloyd______________________/s/ Rose M. Naff________________________
	 	 
	 
	 	 	 	 
	 

	 
	 	 	 	 
	Witness

	 	Rose M. Naff

Executive Director
	 	

	 
	 	 	 	 
	HEALTHEASE AND STAYWELL HMO

	 	 	 	Effective Date; October 1, 2005

Page 26of44

EXHIBIT A

HEALTH SERVICES AGREEMENT

I. Premium Rate

The Comprehensive Health Care Services premium for Participants in the Florida Healthy Kids
Health Insurance Program for the coverage period October 1, 2005 through September 30, 2006
shall be:

	 	 	 
	As to HealthEase:

	 	

	Citrus County:

	 	$89.33 per Participant per month
	 
	 	 
	Duval County:

Escambia County:

Highlands County:

Jefferson County:

Lake County

Madison County:

Martin County:

Putnam County:

Wakulla County:

	 	$105.31 per Participant per month

$93.52 per Participant per month

$103.18 per Participant per month

$90.71 per Participant per month

$68.47 per Participant per month

$90.71 per Participant per month

$92.64 per Participant per month

$85.09 per Participant per month

$89.33 per Participant per month
	 
	 	 
	As to WellCare:

	 	

	Brevard County:

Broward County:

Charlotte County:

Collier County:

Miami-Dade County:

DeSoto County:

Hernando County:

Hillsborough County:

Lee County:

Manatee County:

Orange County:

Osceola County:

Palm Beach County:

Pinellas County:

Sarasota County:

Seminole County:

	 	$83.68 per Participant per month

$89.20 per Participant per month

$90.71 per Participant per month

$90.71 per Participant per month

$89.20 per Participant per month

$90.71 per Participant per month

$115.95 per Participant per month

$73.90 per Participant per month

$89.20 per Participant per month

$90.71 per Participant per month

$73.90 per Participant per month

$73.90 per Participant per month

$89.20 per Participant per month

$73.90 per Participant per month

$90.71 per Participant per month

$73.90 per Participant per month

II. Additional Requirements for Premium Rates

The rate listed in Paragraph I of this Exhibit also incorporates the
following requirements:

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 27 of 44

2

A. Minimum Medical Loss Ratio

	 	 	 	The minimum medical loss ratio shall be eighty-five
percent (85%).

B. Maximum Administrative Component

The maximum administrative cost for the premium listed in Section I of this
Exhibit shall not exceed fifteen percent (15%).

III. Experience Adjustment

In the event that the medical loss ratio for this Agreement is better than eighty-five
percent (85%) in the aggregate for both WellCare and HealthEase calculated in the same
manner as the premium development and allocation methodology utilized in the
insurer’s original rate proposal in its response to the RFP, INSURER shall share
equally with FHKC the dollar difference between the actual loss ratio for said period and
the predicted eighty-five percent (85%).

The INSURER shall provide annually FHKC with a written copy of its findings each year
during the term of this Agreement by February 1st. If any payments are due
under this provision, INSURER shall forward such payment with its written notification.
The INSURER may be subject to audit or verification by FHKC or its designated agents.

FHKC shall determine the adequacy of the information supplied under this section and
whether or not the calculation has been accurately performed in the manner
prescribed below.

The Calculation shall be illustrated in the following manner:

A. Total Premiums Paid During Year: $

B. Target Incurred Claims’: 85% of A

C. Actual Incurred Claims for Year: $

D. Difference Between Target Incurred Claims and Actual Incurred Claims: $ (Subtract

Line C from Line B)

E. Amount Due FHKC (50% of Line D): $

’ The target medical loss ratio for this Agreement and for this calculation is 85%.

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 28 of 44

3

EXHIBIT B

ENROLLMENT PROCEDURES

	 	1	 	All FHKC eligible Participants will be provided with necessary enrollment materials
and forms from FHKC or its assignee.

	 	2.	 	FHKC will provide INSURER with eligible Participants who have selected INSURER or
who have been assigned by FHKC to INSURER according to the provisions of Section 2-1 via
an enrollment report in a format mutually agreed upon by the Parties.	 

	 	3.	 	Upon receipt of each enrollment report, INSURER acting as an agent for FHKC, shall
provide each Participant with an enrollment package within five (5) business days of receipt
of an enrollment report . The enrollment packet shall include, at a minimum, the following
items:

	 	A.	 	A membership card displaying Participant’s name, participation number
and effective date of coverage.	 

	 	B.	 	A Participant’s handbook that complies with any federal requirements and
has been approved by FHKC, including, at a minimum, a description of how to access
services, a listing of the benefits and any co-payment requirements for those
benefits, the insurer’s grievance process, insurer’s customer
services contact information and the rights and responsibilities for both the
Participant and INSURER.

	 	C.	 	A current listing of all primary care physicians, specialists, other
ancillary providers and hospitals available to the Participant and also identifies
the location of the provider’s offices, any age restrictions and contact information
for each provider.

	 	4.	 	Upon receipt of the monthly enrollment files from FHKC, INSURER will process all
enrollments and provide new Participants with an enrollment package as described above within
five (5) business days of receipt of each enrollment report.

	 	5.	 	Deletions will be processed by INSURER and INSURER will notify each cancelled
Participant in

writing by regular mail of the effective date of the cancellation within five (5) business
days of receipt of the enrollment data.

	 	6.	 	In accordance with state law, a minimum waiting period of sixty (60) days will be
imposed on

those Participants who voluntarily cancel their coverage by non-payment of the required
monthly premium. Cancelled Participants must request reinstatement from FHKC and wait at least
sixty (60) days from the date of that request before coverage can be reinstated.

	 	7.	 	FHKC is the sole determiner of eligibility and effective dates of coverage.

	 	8.	 	INSURER must also comply with the guidance issued by the Office of Civil Rights of
the United States Department of Health and Human Services (“Policy Guidance on the Title VI
Prohibition against National Origin Discrimination as it Effects Persons with Limited English
Proficiency”) regarding the availability of information and assistance for persons with
limited English proficiency.

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 29 of 44

4

EXHIBIT C

ENROLLEE BENEFIT SCHEDULE

Minimum Benefits; Statutory Requirements

INSURER agrees to provide, at a minimum, those benefits that are prescribed by state law
under §409.815(2)(a-p). INSURER shall pay an Enrollee’s covered expenses up to a lifetime
maximum of $1 million per covered Enrollee.

	 	 	 	 	 
	
 
	 	The following health care benefits are included under this Agreement:
	 	

	BENEFIT

	 	LIMITATIONS
	 	CO-PAYMENTS

A. Inpatient Services All covered services provided for the medical care and
treatment of an Enrollee who is admitted as an inpatient to a hospital licensed under part I of
Chapter 3 95. Covered services include:

physician’s services; room and board; general nursing care;

patient meals; use of operating room and related facilities; use of intensive care unit and
services; radiological, laboratory and other diagnostic tests; drugs; medications;

biologicals; anesthesia and oxygen services; special duty nursing; radiation and chemotherapy;
respiratory therapy; administration of whole blood plasma; physical, speech and occupational
therapy; medically necessary services of other health professionals.

All admissions must be authorized by INSURER.

The length of the patient stay shall be determined based on

the medical condition of the Enrollee in relation to the

necessary and appropriate level of care.

Room and board may be limited to semi-private

accommodations, unless a private room is considered

medically necessary or semi-private accommodations are

not available.

Private duty nursing limited to circumstances where such

care is medically necessary.

Admissions for rehabilitation and physical therapy are

limited to 15 days per contract year.

Shall Not Include Experimental or Investigational

Procedures as defined as a drug, biological product, device,

medical treatment or procedure that meets any one of the

following criteria, as determined by INSURER.

1. Reliable evidence shows the drug, biological product, device, medical treatment, or procedure
when applied to the circumstances of a particular patient, is the subject of ongoing phase I, II or
III clinical trials or

2. Reliable evidence shows the drug, biological product, device, medical treatment or procedure
when applied to the circumstances of a particular patient, is under study with a written protocol
to determine maximum tolerated dose, toxicity, safety, efficacy, or efficacy in comparison to
conventional alternatives, or

3. Reliable evidence shows the drug, biological product, device, medical treatment, or procedure is
being delivered or should be delivered subject to the approval and supervision of an Institutional
Review Board (IRB) as required and defined by federal regulations, particularly those of the U.S.
Pood and Drug Administration or the Department of Health and Human Services.

NONE

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 30 of 44

5

BENEFIT LIMITATIONS CO-PAYMENTS

B. Emergency Services Covered services include visits to an emergency room or
other licensed facility, if needed immediately, due to an injury or illness and delay means risk of
permanent damage to the Enrollee’s health.

Must use an INSURER designated facility or provider for emergency care unless the time to reach
such facilities or providers would mean the risk of permanent damage to patient’s health.

INSURER must also comply with the provisions ofs. 641.513, Florida Statutes.

$10 per visit waived if admitted or authorized by primary care physician.

Infant is covered for up to three (3) days following birth or until the infant is
transferred to another medical facility, whichever occurs first.

Coverage may be limited to the fee for vaginal deliveries.

C. Maternity Services and Newborn Care Covered services include maternity and newborn care;

prenatal and postnatal care;

initial inpatient care of adolescent Participants, including nursery charges and initial pediatric
or neonatal examination.

NONE

D. Organ Transplantation

Services

Covered services include

pretransplant, transplant and

postdischarge services and

treatment of complications

after transplantation.

Coverage is available for transplants and medically related services if deemed necessary and
appropriate within the guidelines set by the Organ Transplant Advisory Council or the Bone Marrow
Transplant Advisory Council.

NONE

E. Outpatient Services Preventive, diagnostic, therapeutic, palliative care, and
other services provided to an Enrollee in the outpatient portion of a health facility licensed
under chapter 395.

Covered services include well-child care, including those services recommended in the Guidelines
for Health Supervision of Children and Youth as developed by the Academy of Pediatrics;

immunizations and injections as recommended by the Advisory Committee on Immunization Practices;
health education counseling and clinical services; family planning services; vision screening;
hearing screening;

clinical radiological, laboratory and other outpatient diagnostic tests; ambulatory surgical
procedures; splints and casts;

consultation with and treatment by referral physicians;

radiation and chemotherapy;

, chiropractic services; podiatric

Services must be provided directly by INSURER or through pre-approved referrals.

Routine hearing and screening must be provided by primary care physician.

Family planning limited to one annual visit and one supply visit each ninety days.

Chiropractic services shall be provided in the same manner as in the Florida Medicaid program.

Podiatric services are limited to one visit per day totaling two visits per month for specific foot
disorders. Dental services must be provided by an oral surgeon for medically necessary
reconstructive dental surgery due to injury.

Immunizations are to be provided by the primary care physician.

Treatment for temporomandibular joint (TMJ) disease is specifically excluded.

Shall Not Include Experimental or Investigational Procedures as defined as a drug, biological
product, device, medical treatment or procedure that meets any one of the following criteria, as
determined by INSURER:

1. Reliable evidence shows the drug, biological product, device, medical treatment, or procedure
when applied to the circumstances of a particular patient, is the subject of ongoing phase I,
II or III clinical trials or

No Co-Payment for well- child care, preventive care or for routine vision and hearing screenings.

$5 per office visit.

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 31 of 44

6

BENEFIT LIMITATIONS CO-PAYMENTS

services.

2. Reliable evidence shows the drug, biological product, device, medical treatment or procedure
when applied to the circumstances of a particular patient, is under study with a written protocol
to determine maximum tolerated dose, toxicity, safety, efficacy, or efficacy in comparison to
conventional alternatives, or

3. Reliable evidence shows the drug, biological product, device, medical treatment, or procedure,
is being delivered or should be delivered subject to the approval and supervision of an
Institutional Review Board (IRB) as required and defined by federal regulations, particularly those
of the U.S. Food and Drug Administration or the Department of Health and Human Services.

E. Behavioral Health Services Covered services include inpatient and outpatient care
for psychological or psychiatric evaluation, diagnosis and treatment by a licensed mental health
professional.

All services must be provided directly by INSURER or upon approved referral.

Inpatient services are limited to not more than thirty inpatient days per contract year for
psychiatric admissions, or residential services in lieu of inpatient psychiatric admissions;
however, a minimum often of the thirty days shall be available only for inpatient psychiatric
services when authorized by INSURER physician.

Outpatient services are limited to a maximum of forty outpatient visits per contract year.

INPATIENT:

NONE

OUTPATIENT: $5 per visit

F. Substance Abuse Services

Includes coverage for inpatient and outpatient care for drug and alcohol abuse including counseling
and placement assistance.

Outpatient services include evaluation, diagnosis and treatment by a licensed practitioner.

All services must be provided directly by INSURER or upon approved referral.

Inpatient services are limited to not more than seven inpatient days per contract year for medical
detoxification only and thirty days residential services.

Outpatient visits are limited to a maximum of forty visits per contract year.

INPATIENT:

NONE

OUTPATIENT: $5 per visit

G. Therapy Services Covered services include physical, occupational, respiratory and
speech therapies for short-term rehabilitation where significant improvement in the Enrollee’s
condition will result.

All treatments must be performed directly or as authorized by INSURER.

Limited to up to twenty-four treatment sessions within a sixty day period per episode or injury,
with the sixty day period beginning with the first treatment.

$5 per visit

I. Hospice Services Covered services include reasonable and necessary services for
palliation or management of an Enrollee’s terminal illness.

Once a family elects to receive hospice care for an Enrollee, other services which treat the
terminal condition will not be covered.

Services required for conditions totally unrelated to the terminal condition are covered to the
extent that the services are covered under thisAgreement.

$5 per visit

All admissions must be authorized by INSURER and provided by an INSURER affiliated facility.
Participant must require and receive skilled services on a daily basis as ordered by INSURER
physician. The length of the Enrollee’s stay shall be determined by the

J.Nursing Facility Services

Covered services include regular nursing services, rehabilitation services, drugs

NONE

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 32 of 44

	 	 	 	 	 
	BENEFIT LIMITATIONS	CO-PAYMENTS
	 	 	medical condition of the Enrollee in relation to	 	 
	 	 	the necessary and appropriate level of care, but	 	 
	 	 	is no more than 100 days per contract year.	 	 
	 	 	Room and board is limited to semi-private	 	 
	 	 	accommodations unless a private room is	 	 
	 	 	considered medically necessary or semi-private	 	 
	 	 	accommodations are not available. Specialized	 	 
	 	 	treatment centers and independent kidney disease	 	 
	and biologicals, medical	 	treatment centers are excluded. Private duty	 	 
	supplies, and the use of	 	nurses, television, and custodial care are	 	 
	appliances and equipment	 	excluded. Admissions for rehabilitation and	 	 
	furnished by the	 	physical therapy are limited to fifteen days per	 	 
	facility.	 	contract year.	 	 
	K. Durable Medical	 	 	 	 
	Equipment and Prosthetic	 	 	 	 
	Devices Equipment and	 	Equipment and devices must be provided by	 	 
	devices that are	 	authorized INSURER supplier.	 	 
	medically indicated to	 	Covered prosthetic devices include artificial	 	 
	assist in the treatment	 	eyes and limbs, braces, and other artificial	 	 
	of a medical condition	 	aids.	 	 
	and specifically	 	Low vision and telescopic lenses are not included.	 	 
	prescribed as medically	 	Hearing aids are covered only when medically	 	 
	necessary by Enrollee's	 	indicated to assist in the treatment of a medical	 	 
	INSURER physician.	 	condition.	 	NONE
	L. Refractions

	 	Enrollee must have failed vision screening by

primary care physician.

Corrective lenses and frames are limited to one

pair every two years unless head size or

prescription changes.

Coverage is limited to Medicaid frames with

plastic or SYL non-tinted lenses.
	 	$5 per visit

$10 for corrective

lenses

	 
	 	 	 	 
	Examination by an INSURER

optometrist to determine

the need for and to

prescribe corrective

lenses as medically

indicated.

	 	

	 	

	 
	 	 	 	 
	M. Pharmacy

	 	Prescribed drugs covered under this Agreement

shall include all prescribed drugs covered under

the Florida Medicaid program. INSURER may

implement a pharmacy benefit management program

ifFHKC so authorizes. Brand name products are

covered if a generic substitution is not

available or where the prescribing physician

indicates that a brand name is medically

necessary. All medications must be dispensed

through INSURER or an INSURER designated

pharmacy. All prescriptions must be written by

the Participant’s primary care physician, INSURER

approved specialist or consultant physician or

Enrollee’s dental provider.
	 	$5 per prescription

for up to a 31 -day

supply

	 
	 	 	 	 
	Prescribed drugs for the

treatment of illness or

injury.

	 	

	 	

	 
	 	 	 	 
	N. Transportation Services

	 	Must be in response to an emergency situation.
	 	$10 per service
	 
	 	 	 	 
	Emergency transportation

as determined to be

medically necessary in

response to an emergency

situation.

	 	

	 	

II. Cost Sharing Provisions

INSURER agrees to comply with all Cost Sharing restrictions imposed on FHKC Participants by federal
or state laws and regulations, including the following specific provisions:

A. Special Populations

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 33 of 44

7

Enrollees identified by FHKC to INSURER as Native Americans or
Alaskan Natives are prohibited from paying any Cost Sharing amounts.

B. Cost Sharing Limited to No More than Five Percent of Family’s Income

FHKC may identify to INSURER other Enrollees who have met federal requirements
regarding maximum out-of-pocket expenditures. Enrollees identified by FHKC as having
met this threshold are not required to pay any further Cost Sharing for covered
services for a time specified by FHKC.

C. INSURER is responsible for informing its providers of these provisions and ensuring that

Enrollees under this section incur no further out-of-pocket-costs for covered
services and are not denied access to services. FHKC will provide these Enrollees
with a letter indicating that they may not incur any Cost Sharing obligations and
shall provide written notification to INSURER of any such Participants.

III. Other Benefit Provision

All requirements for prior authorizations must conform with federal and state
regulations and must be completed within fourteen (14) days of request by the
Enrollee. Extensions to this process may be granted in accordance with federal and/or
state regulations.

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

8

Page 34 of 44

EXHIBIT D

WORKERS’ COMPENSATION, THIRD PARTY CLAIM,

PERSONAL INJURY PROTECTION BENEFITS,

AND COORDINATION OF BENEFITS

A. WORKERS’ COMPENSATION

Workers’ compensation benefits are primary to all benefits that may be provided pursuant to
this Agreement. In the event INSURER provides services or benefits to a Participant who is
entitled to workers’ compensation benefits, INSURER shall complete and submit to the
appropriate carrier, such forms, assignments, consents and releases as are necessary to
enable INSURER to obtain payment, or reimbursement, under the workers’ compensation law.

B. THIRD PARTY CLAIMS

In the event INSURER provides medical services or benefits to Participants who suffer
injury, disease or illness by virtue of the negligent act or omission of a third party,
INSURER shall be entitled to reimbursement from the Participant, at the prevailing rate, for
the reasonable value of the services or benefits provided. INSURER shall not be entitled to
reimbursement in excess of the Participant’s monetary recovery for medical expenses provided
from the third party.

	 	C.	 	NO-FAULT. PERSONAL INJURY PROTECTION AND MEDICAL PAYMENTS 

	 	 	 	COVERAGE

As noted in the Florida Statutes (F.S. 641.31(8)), automobile no-fault, personal injury
protection, and medical payments insurance, maintained by or for the benefit of the
Participant, shall be primary to all services or benefits that may be provided pursuant to
this Agreement. In the event INSURER provides services or benefits to a Participant who is
entitled to the aforesaid automobile insurance benefits, the parent/guardian or Participant
shall complete and submit to INSURER, or to the automobile insurance carrier, such forms,
assignments, consents and releases as are necessary to enable INSURER to obtain payment or
reimbursement from such automobile insurance carrier.

D. COORDINATION OF BENEFITS AMONG HEALTH INSURERS

INSURER shall coordinate benefits in accordance with NAIC principles as may be amended from
time to time and in accordance with Section 624.91(5)(c).

	 	E.	 	None of the above rules as to coordination of benefits shall limit the Participant’s right to
receive direct health services hereunder.

	 	F.	 	Any Participant claiming benefits under this Agreement shall furnish to INSURER all
information deemed necessary by it to implement this provision.	 

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 3 5 of 44

9

EXHIBIT E

ACCESS and CREDENTIALING STANDARDS

INSURER shall maintain a medical staff, under contract, sufficient to permit reasonably prompt
medical services to all Participants in accordance with the following:

	 	1.	 	Physician and Facility Standards

A. Physician and Medical Provider Standards

insurer’s primary care provider network shall include only board certified
pediatricians and family practice physicians or physician extenders working under the
direct supervision of a board certified practitioner to serve as primary care
physicians in its provider network for the counties covered under this Agreement.

All Primary care physicians must provide covered immunizations to Enrollees.

The INSURER may request that an individual provider be granted an exception to this
policy by making such a request in writing to the corporation and providing the
provider’s curriculum vitae and a reason why the provider should be granted an
exception to the accepted standard. Such requests will be reviewed by the corporation
on a case-by-case basis and a written response will be made to INSURER on the outcome
of the request.

B. Facility Standards

Facilities used for Participants shall meet applicable accreditation and licensure
requirements and meet facility regulations specified by the Agency for Health Care
Administration.

	 	2.	 	Geographical Access:

A. Primary Care Providers

Geographical access to board certified family practice physicians, pediatric
physicians, primary care dental providers or ARNP’s experienced in child health care
of approximately twenty (20) minutes driving time from residence to provider, except
that this driving time limitation shall be reasonably extended in those areas where
such limitation with respect to rural residence is unreasonable. In such instance,
INSURER shall provide access for urgent care through contracts with nearest
providers.

B. Specialty Physician Services

Specialty physician services, ancillary services and specialty hospital services are
to be available within sixty (60) minutes driving time from the Participant’s
residence to provider. Driving time standards may be waived with sufficient
justification if specialty care services are not obtainable due to a limitation of
providers, such as in rural areas.

Timely Treatment:

Timely treatment by providers, such that the Participant shall be seen by a provider in accordance

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

.Page 36 of 44

10

with the following:

A. B. C.

D. E.

Emergency care shall be provided immediately;

Urgently needed care shall be provided within twenty-four (24) hours;

Routine care of patients who do not require emergency or urgently needed care shall be provided
within seven (7) calendar days;

Routine physical examinations shall be provided within four (4) weeks of

Enrollee’s request; and

Follow-up care shall be provided as medically appropriate.

For the purposes of this section, the following definitions shall apply:

Emergency care is that care required for the treatment of an injury or acute illness
that, if not treated immediately, could reasonably result in serious or permanent damage to
the patient’s health.

Urgently needed care is that care required within a twenty-four (24) hour period to
prevent a condition from requiring emergency care.

Routine care is that level of care that can be delayed without anticipated
deterioration in the patient’s medical condition for a period of seven (7) calendar
days.

By utilization of the foregoing standards, FHKC does not intend to create standards of care or
access different from those that are deemed acceptable within the INSURER service area. Rather FHKC
intends that the provider timely and appropriately respond to patient care needs, as they are
presented, in accordance with standards of care existing within the service area. In applying the
foregoing standards, the provider shall give due regard to the ‘evel of discomfort and anxiety of
the patient and/or parent.

In the event FHKC determines that INSURER, or its providers, has failed to meet the access
standards herein set forth, FHKC shall provide INSURER with written notice of non-compliance. Such
notice may be provided via facsimile or other means, specifying the failure in such detail as will
reasonably allow INSURER to investigate and respond. Failure of INSURER to obtain reasonable
compliance or acceptable community care under the following conditions shall constitute a breach of
this Agreement:

A. immediately upon receipt of notice for emergency or urgent
problem; or

B. within ten (10) days of receipt of notice for routine visit
access.

Such breach shall entitle FHKC to such legal and equitable relief as may be appropriate. In
particular, FHKC may direct its Participants to obtain such services outside the Insurer Provider
network as specified in Section 3-2-1 of this Agreement. INSURER shall be financially responsible
for all services under this provision.

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 3 7 of 44

11

EXHIBIT F

ELIGIBILITY STANDARDS

Participant Eligibility Criteria

The following eligibility criteria for participation in the Healthy Kids Program must
be met:

	 	1.	 	The Participants must be children who are age 5 through 18. Participants
who applied for coverage prior to July 1, 1998, and who had attained the age of 19 by
March 31, 2004, are eligible for coverage through their 19th birthday.	 

In accordance with the terms of the Request for Proposals dated April 2004, some
children may have age eligibility from age 18 months through age 4, depending on
their county of residence.

	 	2.	 	Participants must meet the eligibility criteria established under §624.91,
Florida Statutes, and as implemented by FHKC Board of Directors.	 

	 	3.	 	Eligible Participants may enroll during time periods established by FHKC
Board of Directors and in accordance with Section 409.8134(2), Florida Statutes.	 

	 	4.	 	Determination of eligibility for the Healthy Kids Program is made solely
by the Florida Healthy Kids Corporation.	 

	 	5.	 	Any requests by the INSURER for review of a Participant’s eligibility
shall be made exclusively through the procedure set forth in Section 3-6 of this
Agreement.	 

	 	6.	 	If the eligibility requirements set forth in this Exhibit F become in
conflict with the eligibility requirements set forth under Florida law, the
eligibility requirements under Florida law shall control.	 

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 3 8 of 44

12

EXHIBIT G

REPORTING REQUIREMENTS

INSURER shall provide the following reports and data tapes to FHKC according to the time
schedules detailed below. This information shall include all services provided by insurer’s
subcontractors. INSURER is responsible for ensuring that all subcontractors comply with these
reporting requirements.

I. Data Tape

A quarterly data tape shall be prepared that will contain the following data fields.
The tape shall reflect claims and encounters entered during the quarter and shall be
delivered to FHKC according to the time table listed below. INSURER shall also
provide quarterly tapes that reflect claims run-off once this Agreement between
INSURER and FHKC terminates.

REQUIRED DATA FIELDS TO BE CAPTURED

	 	•	 	Provider’s name, address and tax I.D. number (and
payee’s group number if applicable).

	 	•	 	Patient’s name, address, social security number,
I.D. number, birth date, and sex.

	 	•	 	Third party payor information, including amount(s)
paid by other payor(s).

	 	•	 	Primary and secondary diagnosis code(s) and
treatment(s) related to diagnosis.

	 	•	 	Date(s) of service.

	 	•	 	Procedure code(s).

	 	•	 	Unit(s) of service.

	 	•	 	Total charge(s).

	 	•	 	Total payment(s).

Additional required hospital fields include the following:

• Date and type of admission (emergency, outpatient, inpatient,
newborn, etc.).

• For inpatient care: covered days and date of discharge.

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 3 9 of 44

13

EXHIBIT G

(Continued)

Specific pharmacy fields include:

	 	•	 	Pharmacy name and tax I.D. number.

	 	•	 	Other payor information.

	 	•	 	Rx number and date filled.

	 	•	 	National drug code, manufacturer
number, item number, package size, quantity, days supply.	 

	 	•	 	Prescriber’s Florida Department of
Professional Regulations number.

REQUIRED TAPE FORMAT SPECIFICATIONS

	 	 	 	The tape format is as follows or an alternative format as mutually agreed upon by both
parties:	 

	 	•	 	1600 BPI

	 	•	 	EBCDIC

	 	•	 	9 Track

	 	•	 	No labels.

	 	•	 	Each file not to exceed 100 megs in size.

	 	•	 	Fixed record length.

TIME TABLE FOR DELIVERY OF TAPE

	 	 	 
	 
	 	 
	 
	 	 
	For encounters and claims processed during:

	 	Claims tape due to FHKC by:
	 
	 	 
	January 1 — March 31

	 	April 15
	 
	 	 
	April 1 — June 30

	 	July 15
	 
	 	 
	July 1 — September 30

	 	October 15
	 
	 	 
	October 1 — December 31

	 	January 15

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 40 of 44

14

EXHIBIT H

CERTIFICATION REGARDING DEBARMENT, SUSPENSION, INELIGIBILITY, AND VOLUNTARY

EXCLUSION CONTRACTS AND SUBCONTRACTS

This certification is required by the regulations implementing Executive Order 12549, Debarment and
Suspension, signed February 18,1986. The guidelines were published in the May 29,1987, Federal

Register (52 Fed. Reg., pages 20360-20369).

INSTRUCTIONS

A. Each Insurer whose contract\subcontract equals or exceeds $25,000 in federal
monies must sign this certification prior to execution of each contract\subcontract. Additionally,
Insurers who audit federal programs must also sign, regardless of the contract amount. The Florida
Healthy Kids Corporation cannot contract with these types of Insurers if they are debarred or
suspended by the federal government.

B. This certification is a material representation of fact upon which reliance is
placed when this contract\subcontract is entered into. If it is later determined that the signer
knowingly rendered an erroneous certification, the Federal Government may pursue available
remedies, including suspension and/or debarment.

C. The Insurer shall provide immediate written notice to the contract manager at
any time the Insurer learns that its certification was erroneous when submitted or has become
erroneous by reason of changed circumstances.

D. The terms “debarred,” “suspended,” “ineligible,” “person,” “principal,” and
“voluntarily excluded,” as used in this certification, have the meanings set out in the Definitions
and Coverage sections of rules implementing Executive Order 12549. You may contact the contract
manager for assistance in obtaining a copy of those regulations.

E. The Insurer agrees by submitting this certification that it shall not knowingly
enter into any subcontract with a person who is debarred, suspended, declared ineligible, or
voluntarily excluded from participation in this contract/subcontract unless authorized by the
federal government.

F. The Insurer further agrees by submitting this certification that it will require
each subcontractor of this contract/subcontract whose payment will equal or exceed $25,000 in
federal monies, to submit a signed copy of this certification.

G. The Florida Healthy Kids Corporation may rely upon a certification of an Insurer
that it is not debarred, suspended, ineligible, or voluntarily excluded from
contracting\suhcontracting unless it knows that the certification is erroneous.

H. This signed certification must be kept in the contract manager’s file.
Subcontractor’s certifications must be kept at the contractor’s business location.

CERTIFICATION

The prospective Insurer certifies, by signing this certification, that neither he nor his
principals is presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from participation in this contract/subcontract by any federal agency.

Where the prospective Insurer is unable to certify to any of the statements in this certification,
such prospective Insurer shall attach an explanation to this certification.

	 	 	 	 	 
	Signature /s/ Todd S. Farha

Name and Title of Authorized Signee

Todd S. Farha

President and Chief Executive Officer

	 	Date September 28, 2005

	 	

	 
	 	 	 	 
	HEALTHEASE AND STAYWELL HMO

	 	 	 	Effective Date: October 1, 2005

Page 41 of 44

15

EXHIBIT I

CERTIFICATION REGARDING LOBBYING 

CERTIFICATION FOR CONTRACTS, GRANTS. LOANS AND COOPERATIVE AGREEMENTS

The undersigned certifies, to the best of his or her knowledge and belief, that:

	 	(1)	 	No federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or employee
of any agency, a member of congress, an officer or employee of congress, or an employee of a
member of congress in connection with the awarding of any federal contract, the making of any
federal grant, the making of any federal loan, the entering into of any cooperative agreement,
and the extension, continuation, renewal, amendment, or modification of any federal contract,
grant, loan, or cooperative agreement.

	 	(2)	 	If any funds other than federal appropriated funds have been paid or will be paid to
any person for influencing or attempting to influence an officer or employee of any agency,
a member of congress, an officer or employee of congress, or an employee of a member of
congress in connection with this federal contract, grant, loan, or cooperative agreement,
the undersigned shall complete and submit Standard Form-LLL, “Disclosure Form to Report
Lobbying,” in accordance with its instructions.	 

	 	(3)	 	The undersigned shall require that the language of this certification be included in the
award documents for all subawards at all tiers (including subcontracts, subgrants, and
contracts under grants, loans, and cooperative agreements) and that all subrecipients shall
certify and disclose accordingly.

This certification is a material representation of fact upon which reliance was placed when this
transaction was made or entered into. Submission of this certification is a prerequisite for making
or entering into this transaction imposed by section 1352, Title 31, U.S. Code. Any person who
fails to file the required certification shall be subject to a civil penalty of not less than
$10,000 and not more than $100,000 for each such failure.

/s/ Todd S. Farha     September 28,
2005_     

Signature Date

Todd S. Farha      

Name of Authorized Individual

HealthEase of Florida, Inc. and Well Care HMO, Inc. 8725 Henderson Road, Ren 2 Tampa, FL

33634

Name and Address of Organization

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 42 of 44

16

EXHIBIT J

CERTIFICATION

REGARDING HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT OF 1996 COMPLIANCE

This certification is required for compliance with the requirements of the Health Insurance
Portability and Accountability Act of 1996 (HEPAA).

The undersigned INSURER certifies and agrees as to abide by the following:

	 	1.	 	Protected Health Information. For purposes of this Certification, Protected
Health Information shall have the same meaning as the term “protected health information”
in 45 C.F.R. § 164.501, limited to the information created or received by the INSURER from
or on behalf of FHKC.

	 	2.	 	Limits on Use and Disclosure of Protected Health Information (PHI) The INSURER
shall not use or disclose Protected Health Information other than as permitted by this
Agreement or by federal and state law. The INSURER will use appropriate safeguards to
prevent the use or disclosure of Protected Health Information for any purpose not in
conformity with this Agreement and federal and state law. The INSURER will not divulge,
disclose, or communicate in any manner any Protected Health Information to any third party
without prior written consent from FHKC. The INSURER will report to FHKC, within two (2)
business days of discovery, any use or disclosure of Protected Health Information not
provided for in this Agreement of which the INSURER is aware. A violation of this paragraph
shall be a material violation of this Agreement.

	 	3.	 	Use and Disclosure of Information for Management, Administration, and Legal
Responsibilities. The INSURER is permitted to use and disclose Protected Health
Information received from FHKC for the proper management and administration of the INSURER
or to carry out the legal responsibilities of the INSURER, in accordance with 45 C.F.R.
164.504(e)(4). Such disclosure is only permissible where required by law, or where the
INSURER obtains reasonable assurances from the person to whom the Protected Health
Information is disclosed that: (1) the Protected Health Information will be held
confidentially, (2) the Protected Health Information will be used or further disclosed only
as required by law or for the purposes for which it was disclosed to the person, and (3)
the person notifies the INSURER of any instance of which it is aware in which the
confidentiality of the Protected Health Information has been breached.

	 	4.	 	Disclosure to Subcontractors or Agents. The INSURER agrees to enter into a
subcontract with any person, including a subcontractor or agent, to whom it provides
Protected Health Information received from, or created or received by the INSURER on behalf
of, FHKC. Such subcontract shall contain the same terms, conditions, and restrictions that
apply to the INSURER with respect to Protected Health Information.

	 	5.	 	Access to Information. The INSURER shall make Protected Health Information
available in accordance with federal and state law, including providing a right of access
to persons who are the subjects of the Protected Health Information.

	 	6.	 	Amendment and Incorporation of Amendments. The INSURER shall make Protected
Health Information available for amendment and to incorporate any amendments to the
Protected Health Information in accordance with 45 C.F.R. § 164.526.

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 43 of 44

17

	 	7.	 	Accounting for Disclosures. The INSURER shall make Protected Health
Information available as required to provide an accounting of disclosures in
accordance with 45 C.F.R. § 164.528.	 

	 	8.	 	Access to Books and Records. The INSURER shall make its internal practices,
books, and records

relating to the use and disclosure of Protected Health Information received from, or created
or received by the INSURER on behalf of, FHKC to the Secretary of the Department of Health
and Human Services or the Secretary’s designee for purposes of determining compliance with
the Department of Health and Human Services Privacy Regulations.

	 	9.	 	Termination. At the termination of this Agreement, the INSURER shall return
all Protected Health Information that the INSURER still maintains in any form, including
any copies or hybrid or merged databases made by the INSURER; or with prior written
approval of FHKC, the Protected Health Information may be destroyed by the INSURER after
its use. If the Protected Health Information is destroyed pursuant to FHKC’s prior written
approval, the INSURER must provide a written confirmation of such destruction to FHKC. If
return or destruction of the Protected Health Information is determined not feasible by
FHKC, the INSURER agrees to protect the Protected Health Information and treat it as
strictly confidential.

CERTIFICATION     

The INSURER and the Florida Healthy Kids Corporation have caused this Certification to be
signed and delivered by their duly authorized representatives, as of the date set forth
below.

INSURER Name:

Signature /s/ Todd S. Farha  Date September
28, 2005

Todd S. Farha, President and Chief Executive Officer

Name and Title of Authorized Signee

HEALTHEASE AND STAYWELL HMO Effective Date: October 1, 2005

Page 44 of 44

18

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