Document:

h0117benefitattestation.htm

Back to Form 8-K

Exhibit 10.3

Medicare Advantage Attestation of Benefit Plan 

 

WELLCARE OF OHIO, INC.

 

H0117 

 

Date: 08/29/2012

 

I attest that I have examined the Plan Benefit Packages (PBPs) identified below and that the benefits identified in the PBPs are those that the above-stated organization will make available to eligible beneficiaries in the approved service area during program year 2013. I further attest that we have reviewed the bid pricing tools (BPTs) with the certifying actuary and have determined them to be consistent with the PBPs being attested to here.

 

I further attest that these benefits will be offered in accordance with all applicable Medicare program authorizing statutes and regulations and program guidance that CMS has issued to date and will issue during the remainder of 2012 and 2013, including but not limited to, the 2013 Call Letter, the 2013 Solicitations for New Contract Applicants, the Medicare Prescription Drug Benefit Manual, the Medicare Managed Care Manual, and the CMS memoranda issued through the Health Plan Management System (HPMS).

 

 

	
Plan

ID

	
Segment

ID

	
Version

	
Plan

Name

	
Plan

Type

	
Transaction

Type

	
MA

Premium

	
Part D 

Premium

	
CMS Approval

Date

	
Effective

Date

	
005

	
0

	
8

	
WellCare

Value

(HMO)

	
HMO

	
Renewal

	
0.00

	
0.00

	
08/23/2012

	
01/01/2013

	
007

	
0

	
6

	
WellCare

Access

(HMO SNP)

	
HMO

	
Renewal

	
0.00

	
20.10

	
08/20/2012

	
01/01/2013

 

	

H0117 

  

  

  

 

	 THOMAS TRAN	 	 8/29/2012 11:03:44 AM	 
	  	 	 	 
	 Contracting Official Name	 	 Date	 
	 	 	 	 
	 	 	 	 
	 	 	 8735 Henderson Rd	 
	 	 	 Ren 1	 
	 WELLCARE OF OHIO, INC.	 	 Tampa, FL 33634	 
	 	 	 	 
	 Organization	 	 Address	 

 

 

H0117h0712benefitattestation.htm

Back to Form 8-K

Exhibit 10.4

Medicare Advantage Attestation of Benefit Plan 

 

WELLCARE OF CONNECTICUT, INC. 

 

H0712 

 

Date: 08/29/2012

 

I attest that I have examined the Plan Benefit Packages (PBPs) identified below and that the benefits identified in the PBPs are those that the above ­stated organization will make available to eligible beneficiaries in the approved service area during program year 2013. I further attest that we have reviewed the bid pricing tools (BPTs) with the certifying actuary and have determined them to be consistent with the PBPs being attested to here.

 

I further attest that these benefits will be offered in accordance with all applicable Medicare program authorizing statutes and regulations and program guidance that CMS has issued to date and will issue during the remainder of 2012 and 2013, including but not limited to, the 2013 Call Letter, the 2013 Solicitations for New Contract Applicants, the Medicare Prescription Drug Benefit Manual, the Medicare Managed Care Manual, and the CMS memoranda issued through the Health Plan Management System (HPMS).

 

	
Plan

ID

	
Segment

ID

	
Version

	
Plan Name

	
Plan

Type

	
Transaction

Type

	
MA

Premium

	
Part D Premium

	
CMS Approval Date

	
Effective

Date

	
001

	
0

	
8

	
WellCare Choice 

(HMO-POS)

	
HMOPOS

	
Renewal

	
62.60

	
6.40

	
08/24/2012

	
01/01/2013

	
005

	
0

	
6

	
WellCare Access 

(HMO SNP)

	
HMO

	
Renewal

	
0.00

	
28.50

	
08/20/2012

	
01/01/2013

	
019

	
0

	
8

	
Wellcare Value (HMO)

	
HMO

	
Renewal

	
0.00

	
0.00

	
08/24/2012

	
01/01/2013

 

 

 

  H0712

  

  

 

	 THOMAS TRAN	 	 8/29/2012 1:37:16 PM	 
	  	 	 	 
	 Contracting Official Name	 	 Date	 
	 	 	 	 
	 	 	 	 
	 	 	 	 
	 	 	 116 WASHINGTON AVENUE	 
	 WELLCARE OF CONNECTICUT, INC.	 	 NORTH HAVEN, CT 06437	 
	 	 	 	 
	 Organization	 	 Address	 

 

 

 

 

H0712h0913benefitattestation.htm

Back to Form 8-K

Exhibit 10.5

Medicare Advantage Attestation of Benefit Plan 

 

WELLCARE HEALTH PLANS OF NEW JERSEY, INC.

 

H0913

 

 Date: 08/29/2012

 

I attest that I have examined the Plan Benefit Packages (PBPs) identified below and that the benefits identified in the PBPs are those that the above-stated organization will make available to eligible beneficiaries in the approved service area during program year 2013. I further attest that we have reviewed the bid pricing tools (BPTs) with the certifying actuary and have determined them to be consistent with the PBPs being attested to here.

 

I further attest that these benefits will be offered in accordance with all applicable Medicare program authorizing statutes and regulations and program guidance that CMS has issued to date and will issue during the remainder of 2012 and 2013, including but not limited to, the 2013 Call Letter, the 2013 Solicitations for New Contract Applicants, the Medicare Prescription Drug Benefit Manual, the Medicare Managed Care Manual, and the CMS memoranda issued through the Health Plan Management System (HPMS).

 

	
Plan

ID

	
Segment

ID

	
Version

	
Plan

Name

	
Plan

Type

	
Transaction

Type

	
MA

Premium

	
Part D 

Premium

	
CMS

Approval

Date

	
Effective

Date

	
002

	
0

	
7

	
WellCare

Value

(HMO)

	
HMO

	
Renewal

	
0.00

	
0.00

	
08/20/2012

	
01/01/2013

 

	

H0913

  

  

  

 

	 THOMAS TRAN	 	 8/29/2012 1:38:10 PM	 
	  	 	 	 
	 Contracting Official Name	 	 Date	 
	 	 	 	 
	 	 	 	 
	 	 	 	 
	 	 	 P.O. Box 26011	 
	 WELLCARE HEALTH PLANS OF NEW JERSEY, INC.	 	 Tampa, FL 336236011	 
	 	 	 	 
	 Organization	 	 Address	 

 

 

 

H0913h1032benefitattestation.htm

Back to Form 8-K

Exhibit 10.6

Medicare Advantage Attestation of Benefit Plan 

 

WELL CARE OF FLORIDA, INC.

 

H1032 

 

Date: 08/29/2012

 

I attest that I have examined the Plan Benefit Packages (PBPs) identified below and that the benefits identified in the PBPs are those that the above­stated organization will make available to eligible beneficiaries in the approved service area during program year 2013. I further attest that we have reviewed the bid pricing tools (BPTs) with the certifying actuary and have determined them to be consistent with the PBPs being attested to here.

 

I further attest that these benefits will be offered in accordance with all applicable Medicare program authorizing statutes and regulations and program guidance that CMS has issued to date and will issue during the remainder of 2012 and 2013, including but not limited to, the 2013 Call Letter, the 2013 Solicitations for New Contract Applicants, the Medicare Prescription Drug Benefit Manual, the Medicare Managed Care Manual, and the CMS memoranda issued through the Health Plan Management System (HPMS).

 

	
Plan

ID

	
Segment

ID

	
Version

	
Plan Name

	
Plan

Type

	
Transaction

Type

	
MA

Premium

	
Part D Premium

	
CMS Approval Date

	
Effective

Date

	
002

	
0

	
6

	
WellCare Choice (HMO- POS)

	
HMOPOS

	
Renewal

	
39.70

	
0.90

	
08/20/2012

	
01/01/2013

	
008

	
0

	
7

	
WellCare Choice (HMO)

	
HMO

	
Renewal

	
0.00

	
0.00

	
08/20/2012

	
01/01/2013

	
025

	
0

	
7

	
WellCare Choice (HMO- POS)

	
HMOPOS

	
Renewal

	
52.90

	
1.70

	
08/20/2012

	
01/01/2013

	
032

	
0

	
6

	
WellCare Dividend (HMO)

	
HMO

	
Renewal

	
0.00

	
0.00

	
08/20/2012

	
01/01/2013

	
035

	
0

	
6

	
WellCare Value (HMO- POS)

	
HMOPOS

	
Renewal

	
0.00

	
0.00

	
08/20/2012

	
01/01/2013

	
037

	
0

	
6

	
WellCare Advance (HMO)

	
HMO

	
Renewal

	
0.00

	
N/A

	
08/20/2012

	
01/01/2013

	
040

	
0

	
7

	
WellCare Dividend (HMO)

	
HMO

	
Renewal

	
0.00

	
0.00

	
08/20/2012

	
01/01/2013

	
061

	
0

	
6

	
WellCare Select (HMO- POS SNP)

	
HMOPOS

	
Renewal

	
0.00

	
8.50

	
08/20/2012

	
01/01/2013

	
073

	
0

	
7

	
WellCare Value (HMO- POS)

	
HMOPOS

	
Renewal

	
0.00

	
0.00

	
08/20/2012

	
01/01/2013

	
079

	
0

	
7

	
WellCare Value (HMO)

	
HMO

	
Renewal

	
0.00

	
0.00

	
08/20/2012

	
01/01/2013

	
091

	
0

	
6

	
WellCare Value (HMO- POS)

	
HMOPOS

	
Renewal

	
0.00

	
0.00

	
08/20/2012

	
01/01/2013

	
101

	
0

	
6

	
WellCare Select (HMO- POS SNP)

	
HMOPOS

	
Renewal

	
0.00

	
12.50

	
08/20/2012

	
01/01/2013

	
124

	
0

	
6

	
WellCare Liberty (HMO SNP)  

	
HMO

	
Renewal

	
0.00

	
8.70

	
08/20/2012

	
01/01/2013

	
H1032

  

  

  

	 Plan

ID

	 Segment

ID

	 Version	 Plan Name	 Plan

Type

	 Transaction

Type

	 MA

Premium

	
 Part D 

Premium

	
 CMS Approval 

Date

	 Effective

Date

	
133

	
0

	
7

	
WellCare Essential (HMO)

	
HMO

	
Renewal

	
0.00

	
0.00

	
08/20/2012

	
01/01/2013

	
170

	
0

	
6

	
WellCare Liberty (HMO SNP)

	
HMO

	
Renewal

	
0.00

	
11.80

	
08/20/2012

	
01/01/2013

	
173

	
0

	
7

	
WellCare Essential (HMO)

	
HMO

	
Renewal

	
0.00

	
0.00

	
08/20/2012

	
01/01/2013

	
174

	
0

	
7

	
WellCare Essential (HMO)

	
HMO

	
Renewal

	
0.00

	
0.00

	
08/20/2012

	
01/01/2013

	
175

	
0

	
6

	
WellCare Access (HMO SNP)

	
HMO

	
Renewal

	
0.00

	
12.10

	
08/20/2012

	
01/01/2013

	
176

	
0

	
6

	
WellCare Access (HMO SNP)

	
HMO

	
Renewal

	
0.00

	
12.20

	
08/20/2012

	
01/01/2013

	
177

	
0

	
6

	
WellCare Value (HMO- POS)

	
HMOPOS

	
Renewal

	
0.00

	
0.00

	
08/20/2012

	
01/01/2013

	
179

	
0

	
8

	
WellCare Dividend (HMO)

	
HMO

	
Renewal

	
0.00

	
0.00

	
08/20/2012

	
01/01/2013

 

 

 

	
H1032

  

  

  

 

	 THOMAS TRAN	 	 8/29/2012 2:01:31 PM	 
	  	 	 	 
	 Contracting Official Name	 	 Date	 
	 	 	 	 
	 	 	 	 
	 	 	 8735 Henderson Rd	 
	 	 	 Ren 1	 
	 WELL CARE OF FLORIDA, INC.	 	 Tampa, FL 33634	 
	 	 	 	 
	 Organization	 	 Address	 

 

 

 

H1032

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