Document:

floridahealthykidscontract.htm

    Back to Form 8-K

    Exhibit 10.1

    MEDICAL
SERVICES CONTRACT

    

    FLORIDA
HEALTHY KIDS CORPORATION

    

    AND

    

    HEALTHEASE

    

    FOR

    

    Bay,
Citrus, Clay, Duval, Martin, Nassau, and Washington Counties

    

    AND

    

    WELLCARE
HMO/STAYWELL HEALTHPLAN

    

    FOR

    

    Broward,
Miami-Dade, Hernando, Hillsborough, Lee, Orange, Osceola, 

    Palm
Beach, and St. Lucie Counties

    

    Effective:
October 1, 2009

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   _______INSURER

      
        
           

        

        
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    FLORIDA
HEALTHY KIDS CORPORATION

    CONTRACT
FOR MEDICAL SERVICES

    

    TABLE OF
CONTENTS

    

    SECTION
1         DEFINITIONS

    
      	
              1-1

            	
              Applicant

            
	
              1-2

            	
              Children’s
      Health Insurance Program

            
	
              1-3

            	
              Children’s
      Health Insurance Program Re-Authorization Act of 2009

            
	
              1-4

            	
              Children’s
      Medical Services Network

            
	
              1-5

            	
              Commencement
      Date

            
	
              1-6

            	
              Comprehensive
      Medical Care Services

            
	
              1-7

            	
              Contract
      Year

            
	
              1-8

            	
              Co-Payment

            
	
              1-9

            	
              Effective
      Date

            
	
              1-10

            	
              Enrollee

            
	
              1-11

            	
              Executive
      Director

            
	
              1-12

            	
              Federally
      Qualified Health Center

            
	
              1-13

            	
              Florida
      Statutes

            
	
              1-14

            	
              Invitation
      to Negotiate

            
	
              1-15

            	
              Primary
      Care

            
	
              1-16

            	
              Primary
      Care Providers

            
	
              1-17

            	
              Program

            
	
              1-18

            	
              Providers

            
	
              1-19

            	
              Rural
      Health Clinic

            
	
              1-20

            	
              Service
      Area

            
	
              1-20

            	
              Subcontractor

            

    

    

    SECTION
2         FHKC

    
      	
              2-1

            	
              Coordination
      of Benefits

            	 
      
	
              2-2

            	
              Enrollee
      Identification

            
	
              2-3

            	
              Payments
      to Insurer

            
	
              2-4

            	
              Insurer
      Assignment Process

            
	
              2-5

            	
              Monitoring
      by FHKC

            

    

    

    SECTION
3         INSURER
RESPONSIBILITIES

    
      	
              3-1

            	
              General
      Responsibilities

            
	
              3-2

            	
              Access
      to Care

            
	 
      	
              3-2-1

            	
              Enrollment
      with Primary Care Provider (PCP)

            
	 
      	
              3-2-2

            	
              Provider
      Credentialing

            
	 
      	
              3-2-3

            	
              Geographical
      Access

            
	 
      	
              3-2-4

            	
              Appointment
      Standards

            

    

    
      
        	
                3-3

              	
                Failure
      to Provide Access

              
	
                3-4

              	
                Integrity
      of Professional Advice

              
	
                3-5

              	
                Benefits

              
	
                3-6

              	
                Claims
      Payment

              
	
                3-7

              	
                Continuation
      of Coverage upon Termination of This Contract

              
	
                3-8

              	
                Effective
      Date of Enrollee Coverage

              

         

        
          	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

        

      

    

    
      
         

      

      
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              3-9

            	
              Eligibility

            
	
              3-10

            	
              Enrollee
      Protections from Collections

            
	
              3-11

            	
              Enrollment
      Procedures

            
	
              3-12

            	
              Extended
      Coverage

            
	
              3-13

            	
              Fraud
      and Abuse

            
	 
      	
              3-13-1

            	
              definition
      of Fraud and Abuse

            
	 
      	
              3-13-2

            	
              Fraud
      Prevention

            
	
              3-14

            	
              Grievances
      and Complaints

            
	
              3-15

            	
              Indemnification

            
	
              3-16

            	
              Insurance

            
	
              3-17

            	
              Lobbying
      Disclosure

            
	
              3-18

            	
              Medical
      Records Requirements

            
	 
      	
              3-18-1

            	
              Medical
      Quality Review and Audit

            
	 
      	
              3-18-2

            	
              Privacy
      of Medical Records

            
	 
      	
              3-18-3

            	
              Requests
      by Enrollees for Medical Records

            
	
              3-19

            	
              Membership
      and Marketing Materials

            
	 
      	
              3-19-1

            	
              Use
      of FHKC and Florida KidCare Marketing Materials

            
	 
      	
              3-19-2

            	
              Requirements
      for Member Materials

            
	 3-20
      	Notification
      Requirements
	 
      	
              3-20-1

            	
              Immediate
      Notification Requirements

            
	 
      	
              3-20-2

            	
              Monthly
      Notification Requirements

            
	3-21 
      	Premium
      Rate Provisions
	 
      	
              3-21-1

            	
              Premium
      Rate

            
	 
      	
              3-21-2

            	
              Additional
      Requirements for Premium Rates

            
	3-22 
      	Premium
      Rate Modifications
	 
      	
              3-22-1

            	
              Annual
      Adjustment Request

            
	 
      	
              3-22-2

            	
              Annual
      Premium Rate Adjustment Denials

            
	 
      	
              3-22-3

            	
              Change
      in Benefit Schedule

            
	 
      	
              3-22-4

            	
              Specialty
      Fee Arrangements

            
	3-23 
      	Quality
      Management
	 
      	
              3-23-1

            	
              Quality
      Improvement Plans

            
	 
      	
              3-23-2

            	
              Quality
      Improvement Plan Committee

            
	3-24 
      	Records
      Retention and Availability
	3-25 
      	Refusal
      of Coverage
	3-26 
      	Regulatory
      Filings
	3-27 
      	Reporting
      Requirements
	3-28 
      	Subrogation
      Rights
	3-29 
      	Termination
      of Participation
	3-30 
      	Use
      of Subcontractors or Affiliates
	3-31 
      	Reimbursement
      Requirements
	 
      	
              3-31-1

            	
              Out
      of Network Providers

            
	 
      	
              3-31-2

            	
              Reimbursement
      of Federal Qualified Health Centers and Rural Health
    Clinics

            

    

    

    SECTION
4         TERMS AND
CONDITIONS

    

    
      	
              4-1

            	
              Amendment

            
	
              4-2

            	
              Assignment

            
	
              4-3

            	
              Attachments

            

       

      
        	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

      

      
        
          
          

        

        
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              4-4

            	
              Attorney
      Fees

            
	
              4-5

            	
              Bankruptcy

            
	
              4-6

            	
              Change
      of Controlling Interest

            
	
              4-7

            	
              Confidentiality

            
	
              4-8

            	
              Conflicts
      of Interest; Non-Solicitation

            
	 
      	
              4-8-1

            	
              Conflicts
      of Interest

            
	 
      	
              4-8-2

            	
              Gift
      Prohibitions

            
	 
      	
              4-8-3

            	
              Non-Solicitation

            
	
              4-9

            	
              Effective
      Dates

            
	
              4-10

            	
              Entire
      Understanding

            
	
              4-11

            	
              Force
      Majeure

            
	
              4-12

            	
              Governing
      Law; Venue

            
	
              4-13

            	
              Independent
      Contractor

            
	
              4-14

            	
              Name
      and Address of Payee

            
	
              4-15

            	
              Notice
      and Contact

            
	
              4-16

            	
              Severability

            
	
              4-17

            	
              Survival

            
	
              4-18

            	
              Termination
      of Contract

            
	 
      	
              A

            	
              Termination
      for Lack of Funding

            
	 
      	
              B

            	
              Termination
      for Lack of Payment or Performance

            
	 
      	
              C

            	
              Termination
      for Material Breach

            
	 
      	
              D

            	
              Termination
      upon Revision of Applicable Law

            
	 
      	
              E

            	
              Termination
      by FHKC

            

    

    

    ATTACHMENTS

    
      	 
      	
              A

            	
              Certification
      Regarding Debarment

            
	 
      	
              B

            	
              Certification
      Regarding Lobbying

            
	 
      	
              C

            	
              HIPAA
      Business Associate (BA) Agreement

            
	 
      	
              D

            	
              Enrollee
      Benefit Schedule

            
	 
      	
              E

            	
              List
      of Required Reports

            
	 
      	
              F

            	
              Disclosure
      Form

            

    

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
      
         

      

      
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    CONTRACT
TO PROVIDE COMPREHENSIVE MEDICAL SERVICES

    

    THIS Contract is entered into between
the Florida Healthy Kids Corporation (“FHKC”) and WellCare of Florida,
Inc.  (“INSURER”) for comprehensive medical care
services.

    

    SECTION
1         DEFINITIONS

    

    As used
in this Contract, the term:

    

    
      	
              1-1

            	
              “Applicant”
      means a parent or guardian of a child or a child whose disability of
      nonage had been removed under chapter 743, F.S. who applies for
      determination of eligibility for health benefits coverage under ss.
      409.810-820 F.S.

            

    

    

    
      	
              1-2

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

            

    

    

    
      	
              1-3

            	
              “Children’s
      Health Insurance Program Re-Authorization Act of 2009” or “CHIPRA” means
      federal legislation (Public Law 111-3-February 4, 2009) effective April 1,
      2009 that re-authorized the children’s health insurance program through
      September 30, 2013.

            

    

    

    
      	
              1-4

            	
              “Children’s
      Medical Services Network” (CMSN) means the statewide managed care system
      which includes health care providers, as defined in Section 391.021(1),
      F.S., which is financed by Title XXI. CMS network as used under this
      Contract does not include any additional programs and services by or
      through CMS network or which are not funded by Title XXI (such services
      colloquially and collectively known in the regular course of business as
      “the CMS Safety Net Program”).

            

    

    

    
      	
              1-5

            	
              “Commencement
      Date” means that date on which INSURER commenced performance of
      Comprehensive Medical Care Services to
  Enrollees.

            

    

    

    
      	
              1-6

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

            

    

    

    
      	
              1-7

            	
              “Contract
      Year” means October 1 through September 30th.

            

    

    

    
      	
              1-8

            	
              “Co-Payment”
      means the payment required of the Enrollee at the time of obtaining
      service.

            

    

    

    
      	
              1-9

            	
              “Effective
      Date” means the last date on which the last Party to this Contract
      signed.

            

    

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
      
         

      

      
        Page 5 of
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              1-10 
      

            	
              “Enrollee”
      means an individual who meets FHKC standards of eligibility and has been
      enrolled in the Program.

            

    

    

    
      	
              1-11

            	
              “Executive
      Director” means the Executive Director of FHKC as appointed by the FHKC
      Board of Directors.

            

    

    

    
      	
              1-12

            	
              “Federally
      Qualified Health Center” means an entity that is receiving a grant under
      section 330 of the Public Health Service Act, as amended, and Section
      1905(1)(2)(B) of the Social Security Act.  FQHCs provide primary
      health care and related diagnostic services and may provide dental,
      optometric, podiatry, chiropractic and mental health
    services.

            

    

    

    
      	
              1-13

            	
              “Florida
      Statutes” (F.S.) means the Florida Statutes as amended from time to time
      by the Florida Legislature during the term of this
    Contract.

            

    

    

    
      	
              1-14

            	
              “Invitation
      to Negotiate” means the procurement document released by the FHKC to
      competitively secure comprehensive health care services for FHKC
      Enrollees.

            

    

    

    
      	
              1-15

            	
              “Primary
      Care” means comprehensive, coordinated and readily-accessible medical care
      including: health promotion and maintenance; treatment of illness or
      injury; early detection of disease; and referral to specialists when
      appropriate.

            

    

    

    
      	
              1-16

            	
              “Primary
      Care Providers” means those physicians licensed in the State of Florida
      and included in INSURER’s network that are also board certified in
      Pediatrics or Family Medicine or who have received an exemption from such
      standards from FHKC.

            

    

    

    
      	
              1-17

            	
              “Program”
      means the program administered by FHKC as created by and governed under
      section 624.91, F.S. and related state and federal
  laws.

            

    

    

    
      	
              1-18

            	
              “Providers”
      means those providers set forth in INSURER’s Response to the Invitation to
      Negotiate (ITN) and the Enrollee handbook as from time to time may be
      amended.

            

    

    

    
      	
              1-19

            	
              “Rural
      Health Clinic” means a clinic that is located in an area that has a
      health-care provider shortage.  A RHC provides primary health
      care and related diagnostic services and may provide optometric, podiatry,
      chiropractic and mental health services.  A RHC employs,
      contracts or obtains volunteer services from licensed health care
      practitioners to provide services.

            

    

    

    
      	
              1-20

            	
              “Service
      Area” means the designated geographical areas within which the INSURER is
      authorized by the Contract to provide
services.

            

    

    

    
      	
              1-21

            	
              “Subcontractor”
      means any entity or person with whom INSURER has executed a contract to
      perform services covered under this Contract that may have otherwise been
      provided for directly by INSURER.

            

    

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
      
         

      

      
        Page 6 of
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    SECTION
2         FHKC

    

    2-1           Coordination
of Benefits

    

    FHKC
agrees that INSURER may coordinate health benefits with other insurers as
provided for in section 624.91 (5)(c), F.S. and this
Contract.  INSURER also agrees to coordinate benefits with any other
insurer under contract with FHKC to provide comprehensive dental care benefits
to Enrollees, including the provision of prescription coverage by the Enrollee’s
health insurer if prescribed by the Enrollee’s dental provider.

    

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

    

    2-2           Enrollee
Identification

    

    FHKC
shall promptly furnish to INSURER enrollment information to sufficiently
identify Enrollees in the Comprehensive Medical Care Services Plan authorized by
this Contract in accordance with the following:

    

    
      	
               
      

            	
              A.

            	
              Not
      less than seven (7) working days prior to the start of the coverage month,
      FHKC shall provide INSURER a listing of Enrollees eligible for coverage
      that month.

            

    

    

    
      	
               
      

            	
              B.

            	
              By
      the fifth (5th)
      day after the effective date of coverage, FHKC shall also furnish INSURER
      a supplemental listing of eligible Enrollees for that coverage month.
      INSURER shall adjust enrollment retroactively to the first (1st)
      day of that month.

            

    

    

    
      	
               
      

            	
              C.

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

            

    

    

    2-3           Payment
to INSURER

    

    FHKC will
promptly forward the authorized premiums established under Section 3-21 on or
before the first (1st) day
of each month this Contract is in force beginning October 1,
2009.  Premiums are past due if not paid by the fifteenth (15th) day
of each month.  If premiums are past due, INSURER may terminate
coverage under this Contract after giving FHKC notice of the intent to
terminate.  Termination of coverage shall be retroactive to the last
day for which premium payment has been made.

    

    
      	
              2-4

            	
              Insurer
      Assignment Process

            

    

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
      
         

      

      
        Page 7 of
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    Upon
receipt of an application, FHKC shall assign each potential Enrollee to one of
the available plans in the Enrollee’s county of residence based upon factors
designated by FHKC.  Enrollees will have a ninety (90) day free look
period beginning with the Enrollee’s first coverage month with their assigned
plan during which time, the applicant or Enrollee may select another available
plan without cause.  After this ninety (90) day free look period,
Enrollees will be locked until their plan until the Enrollee’s renewal
period.

    

    FHKC will
also notify Enrollees of their right to request disenrollment from their plan
and to select another plan outside of the free look period, if such choice is
available in their county, as follows:

    

    
      	
               
      

            	
              A.

            	
              For
      Cause, at the following times:

            

    

    

    
      	
               
      

            	
              1.

            	
              The
      Enrollee has moved out of INSURER’s service area under this
      Contract;

            

    

     

    
      	
               
      

            	
              2.

            	
              The
      provider does not, because of moral or religions obligations, provide the
      service that the Enrollee needs;

            

    

     

    
      	
               
      

            	
              3.

            	
              The
      Enrollee needs related services to be performed at the same time; not all
      related services are available within the INSURER’s network; and the
      Enrollee’s primary care provider or other provider determines the
      receiving the services separately would subject the enrollee to
      unnecessary risk;

            

    

     

    
      	
               
      

            	
              4.

            	
              The
      Enrollee has an active relationship with a health care provider who is not
      on the INSURER’s network but is in the network of another participating
      health plan that is open to new
enrollees;

            

    

     

    
      	
               
      

            	
              5.

            	
              The
      INSURER no longer participates in the county in which the enrollee
      resides;

            

    

     

    
      	
               
      

            	
              6.

            	
              The
      Enrollee’s health plan is under a quality improvement plan or corrective
      action plan relating to quality of care with FHKC;
  or,

            

    

     

    
      	
               
      

            	
              7.

            	
              Other
      reasons, including but not limited to, poor quality of care, lack of
      access to services or lack of access to providers experienced in providing
      care needed by Enrollee.

            

    

    

    
      	
               
      

            	
              B.

            	
              At
      least every twelve (12) months;

            

    

     

    
      	
               
      

            	
              C.

            	
              When
      FHKC grants the Enrollee the right to change health plans without cause,
      FHKC shall determine the Enrollee’s right to change plans on a
      case-by-case basis.

            

    

    

    
      	
              2-5

            	
              Monitoring
      by FHKC

            

    

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
      
         

      

      
        Page 8 of
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    FHKC will
directly or indirectly conduct periodic monitoring of the INSURER’s operations
for compliance with the provisions of the Contract and applicable federal and
state laws and regulations.

    

    SECTION
3            INSURER
RESPONSIBILITIES

    

    3-1           General
responsibilities

    

    INSURER
shall comply with all provisions of this Contract and its amendments, if any,
and shall act in good faith in the performance of the Contract’s
provisions.  The INSURER shall develop and maintain written policies
and procedures to implement all provisions of this Contract.  INSURER
agrees that failure to comply with all provisions of this Contract, applicable
federal and state laws and regulations, shall result in the termination of the
Contract, in whole or in part, as set forth in this Contract.

    

    3-2           Access
to Care

    

    INSURER
shall meet or exceed the appointment and geographic access standards for
pediatric medical care existing in the community and as specifically provided in
this Contract.

    

    INSURER
shall maintain a medical network, under staff or contract, sufficient to permit
reasonably prompt medical services to all Enrollees in accordance with the terms
of this Contract.

    

    3-2-1      
Enrollment with a Primary Care Provider (PCP)

    

    INSURER
shall offer each Enrollee a choice of Primary Care Providers that meet the
credentialing, access and appointment standards of this
Contract.  INSURER may auto-assign the Enrollee to a PCP that meets
these requirements upon notification of enrollment; however if auto-assignment
is utilized, the Enrollee must be permitted the opportunity to select another
PCP within INSURER’s network that meets these requirements.

    

    INSURER
shall take into consideration, at a minimum, the Enrollee’s last PCP assignment,
if known, closest PCP to Enrollee’s home address, zip code location, sibling
assignments, and age.

    

    INSURER
shall provide each Enrollee the following minimum information within five (5)
business days of notification of enrollment:

    

    
      	
               
      

            	
              A.

            	
              Notification
      of Enrollee’s PCP assignment, including contact information for the
      PCP;

            

    

    

    
      	
               
      

            	
              B.

            	
              The
      Enrollee’s ability to select another PCP from INSURER’s
      network;

            

    

    

    
      	
               
      

            	
              C.

            	
              A
      provider directory; and,

            

    

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
      
         

      

      
        Page 9 of
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              D.

            	
              The
      procedures for changing PCPs.

            

    

    

    3-2-2       Provider
Credentialing

    

    A.    Primary
Care Providers

    

    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.

    

    All
primary care physicians must provide covered immunizations to
Enrollees.

    

    INSURER
may request that an individual Provider be granted an exemption to this
requirement by making such a request in writing to FHKC and submitting the
proposed Provider’s curriculum vitae and stating a reason why the Provider
should be granted an exception. Such requests will be reviewed by FHKC on a case
by case basis and a written response will be made to INSURER on the outcome of
the request.

    

    A medical
home, as defined by the American Academy of Pediatrics, with a board certified
pediatrician or family practice physician or an exemption provider, must be
identified for each Enrollee.

    

    B.     Facility
Standards

    

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

    

    C.     Behavioral
Health Care and Substance Abuse Providers

    

    INSURER
must maintain a provider network either directly or indirectly that includes
qualified provider for child and adolescent substance abuse and behavioral
health care services.

    

    INSURER
and its subcontractors agree to adopt section 394.491, F.S. and Chapter 397,
F.S. as guiding principles in the delivery of services and supports to Enrollees
with mental health and substance abuse disorders.

    

    INSURER
shall ensure that all direct behavioral health services provided to children and
adolescents under this Contract are delivered by individuals or entities who
meet the minimal licensure and credentialing standards set forth in statutes and
rules of the Department of Children and Family Services, the Department of
Health, and the Division of Medical Quality Assurance of the Agency for Health
Care Administration, pertinent to the treatment and prevention of mental health
and substance abuse disorders in children and adolescents.

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
      
         

      

      
        Page 10
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    INSURER,
at a minimum, shall include within its subcontracted behavioral health care
resources a psychiatric hospital licensed under Chapter 395, F. S., a crisis
stabilization unit licensed under Chapter 394, F. S., and an addiction receiving
facility, licensed under Chapter 397, F. S., which an enrolled child or
adolescent may access as needed.

    

    INSURER’s
provider network shall also include board certified child psychiatrists or
practitioners licensed to practice medicine, osteopathic medicine, psychology,
clinical social work, mental health counseling, or marriage and family therapy
with a minimum of 2 (two) years full-time, post graduate, paid experience
providing mental health and/or substance abuse services in a setting that
specializes in providing mental health and/or substance abuse services to
children and/or adolescents.

    

    3-2-3       Geographical
Access

    

    A.    Primary Care
Medical Providers

    

    Geographical
access to board certified family practice physicians, pediatric physicians,
primary care providers or Advanced Registered Nurse Practitioner’s (ARNP),
experienced in child health care, of approximately twenty (20) minutes driving
time from residence to Provider. This driving time limitation may be reasonably
extended in those areas where such limitation with respect to rural residences
is unreasonable.  In such instance, INSURER shall provide access for
urgent care through contracts with the closest available Providers.

    

    B.     Specialty Care
Medical Providers

    

    Specialty
medical services, ancillary services and hospital services are to be available
within sixty (60) minutes driving time from Enrollee’s residence to Provider.
The driving time limitation may be reasonably extended or waived in those areas
where such limitation with respect to rural residences is
unreasonable.

    

                   
3-2-4       Appointment
Standards

    

    A.    Definitions

    

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

    

    
      	
               
      

            	
              1.

            	
              “Emergency
      care” means the level of 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 Enrollee’s
  health.

            

    

    

    
      	
               
      

            	
              2.

            	
              “Urgently
      needed care” or “Urgent Care” means the level of care that is required
      within a twenty-four (24) hour period
      to prevent a condition from requiring emergency
    care.

            

    

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
      
         

      

      
        Page 11
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              3.

            	
              “Routine
      care” means the level of care can be delayed without anticipated
      deterioration in the Enrollee’s condition for a period of seven (7)
      calendar days.

            

    

    

    
      	
               
      

            	
              4.

            	
              “Routine
      physical examinations” means the Enrollee’s annual physical examination by
      the Enrollee’s primary care provider in accordance with the schedule
      established by the American Academy of
  Pediatrics.

            

    

    

    B.     Appointment
Access

    

    INSURER
shall provide timely treatment for Enrollees in accordance with the following
standards:

    

    
      	
               
      

            	
              1.

            	
              Emergency
      care shall be provided immediately.

            

    

    

    
      	
               
      

            	
              2.

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

            

    

     

    
      	
               
      

            	
              3.

            	
              Routine
      care of Enrollees who do not require emergency or urgent care shall be
      provided within seven (7) calendar days of the Enrollee’s request for
      services.

            

    

     

    
      	
               
      

            	
              4.

            	
              Routine
      physical examinations shall be provided within four (4) weeks of the
      Enrollee’s request.

            

    

     

    
      	
               
      

            	
              5.

            	
              Follow-up
      care shall be provided as medically
appropriate.

            

    

     

    By
utilization of the foregoing standards, FHKC does not intend to create standards
of care or access to care different than those deemed acceptable within
INSURER’s service area. Rather, FHKC intends that INSURER and its Providers
timely and appropriately respond to Enrollee needs, as they are presented, in
accordance with standards of care existing within the service
area.  In applying these standards, INSURER and Provider shall give
due regard to the level of discomfort and anxiety of the Enrollees and their
families.

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
      
         

      

      
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    3-3           Failure
to Provide Access

    

    In the
event FHKC determines that INSURER or its Providers, has failed to meet the
access standards established in this Contract, FHKC shall notify INSURER of its
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 within five (5) business days for non-emergency care.
Response to emergency or urgent non-compliance issues must be immediate upon
receipt of notice.

    

    If any
such failure to provide access constitutes a material breach of this Contract,
as determined by FHKC in its sole discretion, such material breach shall entitle
FHKC to unilaterally terminate this Contract.  Termination for
material breach shall proceed pursuant to Section 4-18(C).

    

    Upon FHKC
identifying a material breach by INSURER, to address the ongoing health care
needs of Enrollees, FHKC may direct Enrollees to seek such services outside of
INSURER’s Provider network. Should FHKC direct such action, INSURER shall be
financially responsible for all such services.

    

    3-4           Integrity
of Professional Advice to Enrollees

    

    INSURER
must comply with section 457.985, Code of Federal Regulation (CFR) which
prohibits INSURER from interfering with the advice of health care professionals
to Enrollees and requires that professionals engaged in the performance of
INSURER’s duties under this Contract give information about treatments to
Enrollees and their families as provided by law.

    

    Likewise,
INSURER agrees to comply with section 457.985, CFR and any other applicable
federal or state laws and regulations related to physician incentive plans
including any disclosure requirements related to such incentive
plans.

    

    3-5           Benefits

    

    INSURER
agrees to make its provider network available to Enrollees in those counties
designated under Section 3-21 and to provide the Comprehensive Medical Care
Services in this Contract.

    

    3-6           Claims
Payment

    

    INSURER
will pay any claims from its offices located at 5404 Cypress Center Drive, Suite
300 Tampa, FL 33609 or any other designated claims office located in its service
area.  INSURER will pay clean claims filed within thirty (30) business
days or request additional information of the claimant necessary to process the
claim.

    

    3-7           Continuation
of Coverage upon Termination of this Contract

    

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

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
      
         

      

      
        Page 13
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    If
INSURER terminates this Contract at its sole option and through no fault of
FHKC, and if on the date of termination an Enrollee is totally disabled and such
disability commenced while coverage was in effect, that Enrollee shall continue
to receive all benefits otherwise available under this Contract for the
condition under treatment which caused such total disability until the earlier
of:

    

    A.           Expiration
of the contract benefit period for such benefits;

    

    
      	
               
      

            	
              B.

            	
              Determination
      by the Medical Director of INSURER that treatment is no longer medically
      necessary;

            

    

    

    
      	
               
      

            	
              C.

            	
              Expiration
      of twelve (12) months from the date of termination of coverage;
      or,

            

    

    

    
      	
               
      

            	
              D.

            	
              Election
      by a succeeding carrier to provide replacement coverage without limitation
      as to the disabling condition.

            

    

    

    However,
these benefits will be provided only so long as the Enrollee is continuously
totally disabled and only for the illness or injury which caused the total
disability.

    

    For
purposes of this section, an Enrollee who is “totally disabled” shall mean an
Enrollee 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
Enrollee is suited by education, training, experience or
ability.  Pregnancy, childbirth or hospitalization in and of
themselves does not constitute “total disability”. In the case of maternity
coverage, when an Enrollee 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 limited to the maternity
services and newborn care benefits provided under this Contract and shall not be
based on total disability.

    

    3-8           Effective
Date of Enrollee Coverage

    

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

    

    3-9           Eligibility

    

    INSURER
shall accept those Enrollees which FHKC has determined meet the Program’s
eligibility requirements.

    

    A.           Program
Eligibility

    

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

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
      
         

      

      
        Page 14
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                1.

              	
                Enrollees
      must be children who are age five (5) years through eighteen (18) years.
      Age eligibility shall end on the last day of the month in which the
      Enrollee 

                  attains
      age nineteen (19).  Age eligibility is based on the Enrollee’s
      age as of the first day of the coverage
  month.

                

              

      

       

    

    
      	
               
      

            	
              2.

            	
              Enrollees
      must meet the eligibility criteria established under section 624.91, F.S.
      and as implemented by the FHKC Board of
  Directors.

            

    

    

    
      	
               
      

            	
              3.

            	
              Eligible
      Enrollees may enroll during time periods established by FHKC Board of
      Directors in accordance with section 624.91,
  F.S.

            

    

    

    
      	
               
      

            	
              4.

            	
              Determination
      of eligibility for the Program is made solely by
  FHKC.

            

    

    

    B.       
    Requests for Eligibility Review

    

    If
INSURER has reasonable cause to believe that an Enrollee is not eligible for the
Program because that Enrollee should in fact be placed in a different state or
federal program for such services which eligibility would render that Enrollee
ineligible for the Program, INSURER may request in writing that FHKC review the
eligibility of that Enrollee. FHKC shall ensure that all records and findings
maintained by FHKC concerning a particular eligibility determination will be
made available to INSURER with reasonable promptness to the extent permitted
under sections 624.91 and 409.821, F.S. regarding confidentiality of information
held by FHKC and the Florida KidCare program.

    

    C.       
    Eligibility Dispute Process

    

    If after
review under this section, INSURER and FHKC dispute whether or not an Enrollee
is eligible for the Program, upon payment of a one hundred dollar ($100.00) fee
to FHKC from INSURER, FHKC will seek an independent determination of eligibility
from the entity administering the comparable federal or state insurance program
for which INSURER alleges the Enrollee is eligible.  Both INSURER and
FHKC agree to be bound by the response of the entity receiving the request under
this provision.  INSURER and FHKC agree that the rights and remedies
provided under this section shall be exclusive as to eligibility
disputes.

    

    If an
Enrollee is determined not to be eligible for the Program and INSURER included
that Enrollee in an actuarial memorandum to support a premium or rate
modification request under this Contract, then INSURER shall submit to FHKC a
revised supporting actuarial memorandum which excludes that
Enrollee.

    

    3-10         Enrollee
Protections from Collection

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
      
         

      

      
        Page 15
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    Neither
INSURER nor any representative of INSURER shall collect or attempt to collect
from an Enrollee any money for services covered by the Program or any monies
owed by FHKC to INSURER.

    

    3-11         Enrollment
Procedures

    

    Within
five (5) business days of receipt of an enrollment file specified under Section
2-2, INSURER shall provide each Enrollee with an enrollment package. The
enrollment package shall include, at a minimum, the following
items:

    

    
      	
               
      

            	
              A.

            	
              A
      membership card displaying the Enrollee’s name, identification number and
      effective date of coverage as well as any other information required by
      state or federal law.

            

    

    

    
      	
               
      

            	
              B.

            	
              An
      Enrollee handbook that complies with any federal or state requirements and
      has been approved by FHKC.  The handbook shall include a
      description of how to access services, a listing of any Co-Payment
      requirements, INSURER’s grievance process and the covered benefits.
      Co-Payment requirements shall specifically explain that in the event the
      Enrollee fails to pay the required Co-Payment, INSURER may decline to
      provide non-emergency or non-urgently needed care unless the Enrollee
      meets the conditions of waiver of Co-Payments described in Attachment
      D.

            

    

    

    
      	
               
      

            	
              C.

            	
              A
      current listing of all participating primary care physicians, specialists
      and other medical providers that includes the address, office hours and
      any age limitations for each
Provider.

            

    

    

    Any
cancellation of Enrollees from coverage shall be processed timely by INSURER
upon receipt of the monthly enrollment files. INSURER will provide written
notice of the effective date of cancellation, by regular mail, to each affected
Enrollee within five (5) business days of receipt of such
information.

    

    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 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.

    

    3-12         Extended
Coverage

    

    Except
for terminations resulting from fraud, INSURER agrees to offer individual
coverage to all terminated Enrollees without regard to health condition
status.

    

    
      	
              3-12

            	
              Fraud
      and Abuse

            

    

     

    
      	
                             
      3-13-1

            	
              Definition
      of Fraud and Abuse

            

    

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
      
         

      

      
        Page 16
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    The
following acts by a FHKC Applicant, Enrollee or other person are considered
Fraud:

    

    
      	
               
      

            	
              A.

            	
              Knowingly
      failing by any false statement, misrepresentation, impersonation, or other
      fraudulent means, to disclose any material fact necessarily used in making
      the determination as to such person’s qualification to receive
      Comprehensive Medical Care Services coverage under the
      Program;

            

    

    

    
      	
               
      

            	
              B.

            	
              Knowingly
      failing to disclose a change in circumstances in order to obtain or
      continue to receive Comprehensive Medical Care Services under the Program
      to which he or she is not entitled or in an amount larger than that to
      which he or she is entitled.

            

    

    

    
      	
               
      

            	
              C.

            	
              Using
      or attempting to use, transfer, acquire, traffic, alter, forge, or possess
      a FHKC identification card to which he or she is not
    entitled.

            

    

    

    
      	
               
      

            	
              D.

            	
              Committing
      any act subject to prosecution under Section 409.814,
  F.S.

            

    

    

    
      	
               
      

            	
              E.

            	
              Aiding
      or abetting another person in the commission of any act under this
      definition.

            

    

    

    3-13-2     Fraud
Prevention

    

    INSURER
shall have in place appropriate preventative and detection measures which ensure
against fraud and abuse as defined in this Contract that complies with all state
and federal laws and regulatory requirements, including the applicable
provisions of 42 CFR 438.608, 42 CFR 4559(a)(2) and Section 409.814,
F.S.

    

    FHKC
shall have access to monitor such fraud and abuse prevention activities
conducted by INSURER. If INSURER obtains information demonstrating or indicating
fraud by subcontractors, Applicants or Enrollees, INSURER shall report its
findings to FHKC for investigation.

    

    At a
minimum, INSURER’s fraud and abuse program shall include:

    

    
      	
               
      

            	
              A.

            	
              A
      compliance officer with sufficient experience in health care who shall
      have the responsibility and authority for carrying out the provisions of
      the Fraud and Abuse policies of procedures of
  INSURER.

            

    

    
      	
               
      

            	
              B.

            	
              Adequate
      staffing and resources to investigate unusual incidents and to develop
      corrective action plans to assist INSURER with preventing and detecting
      potential Fraud and Abuse
activities.

            

    

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
      
         

      

      
        Page 17
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              C.

            	
              Submission
      of INSURER’s Fraud and Abuse policies to FHKC within thirty (30) calendar
      days of initial execution of this Contract and then annually thereafter by
      July 1st.

            

    

    

    
      	
               
      

            	
              D.

            	
              Internal
      controls and policies and procedures that are designed to prevent, detect,
      and report known or suspected Fraud and Abuse
  activities.

            

    

    

    
      	
               
      

            	
              E.

            	
              Provisions
      for the investigation and follow-up of any reports notification to FHKC
      of, including but not limited to, any fraud by subcontractors, Applicants
      or Enrollees

            

    

    

    
      	
               
      

            	
              F.

            	
              Cooperation
      in any investigation by FHKC, State, or Federal entities or any subsequent
      legal action that may result from such an
  investigation.

            

    

    

    
      	
               
      

            	
              G.

            	
              Non-retaliation
      policies against any individual that reports violations of INSURER’s Fraud
      and Abuse policies and procedures or suspected Fraud and
      Abuse.

            

    

    

    
      	
               
      

            	
              H.

            	
              Distribute
      written Fraud and abuse policies to its employees in accordance with
      Section 6032 of the federal Deficit Reduction Act of 2005, including the
      rights of employees to be protected as
  whistleblowers.

            

    

    

    3-14         Grievances
and Complaints

    

    INSURER
agrees to provide a grievance process for all Enrollees. Any such grievance
process shall be governed by applicable federal and state laws and
regulations.

    

    INSURER
shall provide to FHKC a copy of INSURER’s current grievance process for
Enrollees upon execution of this Contract and then annually by July 1st.  Additionally,
INSURER shall provide FHKC with notice of any proposed changes to the process.
Such changes must be reviewed and approved by FHKC prior to
implementation.

    

    INSURER
shall maintain a record of all formal and informal grievances that includes the
date, name, nature and disposition of each grievance. INSURER shall provide FHKC
with a quarterly report of all grievances and complaints received by INSURER
involving Enrollees. 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 prior to their presentation at the
panel.

    

    3-15    
    Indemnification

    

    INSURER
agrees to indemnify and hold FHKC harmless 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.

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
      
         

      

      
        Page 18
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    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 negligence or intentional torts by
INSURER.

    

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

    

    INSURER
agrees to indemnify, defend and hold 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 performing or supplying of services, materials or
      supplies in connection with the performance of this Contract regardless of
      whether or not 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 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
      right of indemnification given herein, FHKC agrees to provide to INSURER,
      if known, 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.

            

    

    

    3-16         Insurance

    

    INSURER
shall not commit any work in connection with this Contract until it has obtained
all types and levels of insurance required and approved by the appropriate state
regulatory agencies.  The insurance includes but is not limited to
worker’s compensation, liability, fire insurance and property
insurance.  FHKC shall be provided proof of coverage of insurance by a
certificate of insurance within ten (10) business days of contract execution.
Continuing evidence of insurance coverage must be provided to FHKC by July
1st of
each year.

    

    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 deductible
shall be the sole responsibility of INSURER or subcontractor holding such
insurance.  The same holds true of any premiums paid on any insurance
policy pursuant to this Contract.

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
       

       

    

    
      Page 19
of 63

      
        

      

    

    
       

    

    Failure
to provide proof of coverage shall constitute a material breach under Section
4-18(C).

    

    3-17         Lobbying
Disclosure

    

    INSURER
shall comply with applicable state and federal requirements for the disclosure
of information regarding lobbying activities of INSURER, 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.

    

    3-18         Medical
Records Requirements

    

    INSURER
shall require Providers to maintain medical records for each Enrollee under this
Contract in accordance with applicable federal and state law.

    

    3-18-1     Medical
Quality Review and Audit

    

    FHKC
shall conduct an independent medical quality review of INSURER during this
Contract term.  The independent auditor’s report will include a
written review and evaluation of care provided to
Enrollees.  Additional reviews may also 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.

    

    3-18-2     Privacy of
Medical Records

    

    INSURER
shall maintain all individual medical records with confidentiality and 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 shall comply with the Health Insurance
Portability and Accountability Act of 1996 (HIPAA), as amended from time to
time, and shall include provisions for when an Enrollee’s protected health
information may be used or disclosed without consent or
authorization.

    

    3-18-3     Requests by
Enrollees for Medical Records

    

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

    

    3-19         Membership
and Marketing Materials

    

    3-19-1     Use
of FHKC and Florida KidCare Marketing Materials                

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
       

       

    

    
      Page 20
of 63

      
        

      

    

    
       

    

    
    

    INSURER
shall not utilize the marketing materials, logos, trade names, service marks or
other materials belonging
to FHKC without FHKC’s written consent.  Written authorization must be
received for each individual use or activity.

     

    INSURER
also may not utilize any marketing materials, logos, trade names, service marks
or other materials identifying the Florida KidCare program without obtaining
prior written authorization from the state agency holding the rights to such
names or marks.

    

    3-19-2     Requirements
for Member Materials

    

    INSURER
is responsible for all preparation, cost and distribution of member handbooks,
plan documents and other membership materials, as well as orientation for
Enrollees.  Information must be provided at a reading level of not
greater than a fourth (4th)
grade comprehensive level.

    

    
      	
               
      

            	
              A.

            	
              Cultural
      Competency

            

    

    

    Materials
must be appropriate to the population served including, but not limited to,
alternate language access in accordance with federal requirements, and must be
unique to the Program.

    

    In
accordance with 42 CFR 438.206, INSURER shall have a comprehensive written
Cultural Competency Plan describing how INSURER will ensure that services are
provided in a culturally competent manner to all Enrollees, including those with
limited English proficiency.  The Cultural Competency Plan must
describe how the INSURER, its providers, employees and systems will effectively
provide services to people of all cultures, races, ethnic backgrounds, and
religions in a manner that recognizes, affirms, and respects the worth of the
Enrollee and protects and preserves the dignity of each.

    

    INSURER
shall submit its plan under this Section upon execution of this Contract for
approval by FHKC.

    

    
      	
               
      

            	
              B.

            	
              Translation
      Services

            

    

    

    INSURER
is required to provide oral translation services of information to any Enrollee
who speaks any non-English language regardless of whether an Enrollee speaks a
language that meets the threshold of a prevalent non-English
language.  INSURER is required to notify Enrollees of the availability
of oral interpretations services and to inform them of how to access such
services.  There shall be no charge to the Enrollee for translation
services.

    

    
      	
               
      

            	
              C.

            	
              Minimum
      Requirements for Member
Notifications

            

    

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
       

       

    

    
      Page 21
of 63

      
        

      

    

    
       

    

              
     At a minimum, INSURER shall ensure that all Enrollees
are made aware of the following:

    

    
      	
               
      

            	
              1.

            	
              The
      rights and responsibilities of both the Enrollee and
    INSURER;

            

    

     

    
      	
               
      

            	
              2.

            	
              The
      role of the PCP;

            

    

     

    
      	
               
      

            	
              3.

            	
              What
      to do in an emergency or urgent medical
  situation;

            

    

     

    
      	
               
      

            	
              4.

            	
              How
      to request a Grievance, Appeal or contact the Subscriber Assistance
      Panel;

            

    

     

    
      	
               
      

            	
              5.

            	
              How
      to report fraud and abuse;

            

    

     

    
      	
               
      

            	
              6.

            	
              Procedures
      for referrals and prior authorizations, including prescription
      coverage;

            

    

     

    
      	
               
      

            	
              7.

            	
              How
      to acquire behavioral health and substance abuse
  services;

            

    

     

    
      	
               
      

            	
              8.

            	
              Any
      additional telephone numbers or contact information for reaching INSURER;
      and,

            

    

     

    
      	
               
      

            	
              9.

            	
              Eligibility
      compliance requirements under the Program, specifically for payment of
      premiums and renewal.

            

    

    

    
      	
               
      

            	
              D.

            	
              FHKC
      Approval and Review

            

    

    

    All
Enrollee handbooks, forms and member materials must be approved by FHKC prior to
distribution.  In addition, INSURER agrees to annually provide FHKC
with a copy of all previously approved membership materials for review by July
1st.

    

    
      	
               
      

            	
              E.

            	
              Direct
      Marketing Restrictions

            

    

    

    INSURER
may engage in marketing activities subject to the prior written review and
approval of any such events, materials and activities by FHKC. INSURER will
submit scheduled events at least one (1) week in advance of the event if
materials for such event have not been previously approved by FHKC. All other
events must be approved at least twenty-four (24) hours in advance. INSURER will
use only marketing materials which have been approved in writing by
FHKC.

    

    INSURER
may also implement retention efforts directed at its current Enrollees subject
to the review and written approval of FHKC.

    

    
      	
               
      

            	
              F.

            	
              Use
      of Insurer’s Name

            

    

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
       

       

    

    
      Page 22
of 63

      
        

      

    

    
       

    

    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.
INSURER reserves the right to review and concur in any such marketing materials
prior to dissemination.

    

    3-20         Notification
Requirements

    

    A.           Immediate
Notification Requirements

    

    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 services under Chapter 641, Part II,
F.S.

            

    

    

    
      	
               
      

            	
              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, F.S. or an admission seeking relief provided
    therein.

            

    

    

    
      	
               
      

            	
              3.

            	
              Any
      petition or order of rehabilitation or liquidation as provided in Chapter
      631 or 641, F.S.

            

    

    

    
      	
               
      

            	
              4.

            	
              Any
      order revoking INSURER’s Certificate of
  Authority.

            

    

    

    
      	
               
      

            	
              5.

            	
              Any
      administrative action taken by the Department of Financial Services,
      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 an Enrollee is
      a party (or in which Enrollee’s allegations are to be
      litigated).

            

    

    

    
      	
               
      

            	
              7.

            	
              The
      filing of an application for change in ownership that is greater than five
      percent (5%) with the Florida Department of Financial Services or the
      Office of Insurance Regulation.

            

    

    

    
      	
               
      

            	
              8.

            	
              Any
      pending litigation or commencement of legal action involving INSURER in
      which liability for or INSURER’s obligation to pay could exceed five
      hundred thousand dollars ($500,000.00) or ten percent (10%) of INSURER’s
      surplus.

            

    

    

    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 Enrollees on its panels.  FHKC may require INSURER to
provide FHKC with evidence that its provider network continues to meet the
access to care requirements under this Contract.

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
       

       

    

    
      Page 23
of 63

      
        

      

    

    
       

    

     

    3-21         Premium
Rate Provisions

    

    3-21-1     Premium
Rate

    

    The
premium rate charged for the provision of Comprehensive Medical Care Services
for October 1, 2009 through September 30, 2010 shall be as follows:

    

    As to
HealthEase:

    

    
      	
              COUNTY

            	
              PER
      MEMBER PER MONTH

            
	
              Bay

            	
              $120.21

            
	
              Citrus

            	
              $97.90

            
	
              Clay

            	
              $100.41

            
	
              Duval

            	
              $97.33

            
	
              Martin

            	
              $104.23

            
	
              Nassau

            	
              $100.29

            
	
              Washington

            	
              $119.61

            

    

     

                   
As to StayWell:

    

    
      	
              COUNTY

            	
              PER
      MEMBER PER MONTH

            
	
              Broward

            	
              $117.46

            
	
              Miami-Dade

            	
              $106.63

            
	
              Hernando

            	
              $111.97

            
	
              Hillsborough

            	
              $101.46

            
	
              Lee

            	
              $121.40

            
	
              Orange

            	
              $116.49

            
	
              Osceola

            	
              $87.86

            
	
              Palm
      Beach

            	
              $92.01

            
	
              St.
      Lucie

            	
              
                $98.09  
      $98.90                         
      _________FHKC 

                                                                     /s/
      HS          INSURER

                

              

            

 

    3-21-2     Additional
Requirements for Premium Rates

    

    
      	
               
      

            	
              A.

            	
              Minimum
      Medical Loss Ratio

            

    

    

    
      	
               
      

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

            

    

    
    

    

    INSURER
must submit a quarterly medical loss ratio report with results presented by
month with claims incurred to date, by county as well for INSURER’s entire block
of business covered under this Contract.

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
       

       

    

    
      Page 24
of 63

      
        

      

    

    
       

    

    This
ongoing report should be updated each quarter to include any updated claims
information received since the prior quarterly report.

    

    The
report is due by the end of the second month following the close of the quarter
as follows:

    

    
      	 	
              January
      1 – March 30:

            	 
      	
              May
      31st

            
	 	
              April
      1 – June 30:

            	 
      	
              August
      31st

            
	 	
              July
      1 – September 30:

            	 
      	
              November
      30th

            
	 	
              October
      1 – December 31:

            	 
      	
              February
      28th

            

    

    

    If the
reporting deadline falls on a holiday or weekend, the report is due on the next
business day.

    

    
      	
               
      

            	
              B.

            	
              Maximum
      Administrative Component

            

    

    

    The
maximum administrative component shall not exceed fifteen (15%)
percent.

    

    3-21-3   
 Experience Adjustment

    

    In the
event that the actual medical loss ratio (MLR) that the INSURER achieves for
this CONTRACT is better than eighty five percent (85%), calculated in the same
manner as the premium development and allocation methodology utilized in
INSURER’s ITN response. INSURER shall return to FHKC a share of the dollar
difference between the INSURER’s actual MLR for said period and the projected
minimum MLR of eighty five percent (85%) based on the following tiered
Experience Adjustment schedule:

    

    A.         
  Tier I:  MLR of 84.99 to 82.00
Percent:                       50%
to FHKC

                   
(84.99% to 82.00%)

    

    B.         
   Tier II:  MLR of 81.99 Percent or
Less:                     100%
to FHKC

    (81.99% or less)

    

    If
INSURER’s actual MLR is less than eighty-five percent (85%) during a Contract
Year, but not lower than eighty two percent (82%), INSURER shall return to FHKC
fifty percent (50%) of the difference between the actual MLR and the projected
minimum MLR of eighty five percent (85%), pursuant to sub-paragraph 3-21-3A Tier
I.

    

    If
INSURER’S actual MLR is less than eighty-two percent (82%) during any Contract
Year, INSURER shall return to FHKC the sum of the Tier I and Tier II experience
adjustment pursuant to sub- paragraph 3-21-3A and B, as follows:

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
       

       

    

    
      Page 25
of 63

      
        

      

    

    
       

    

                  
1)         
    fifty percent (50%) of the difference between INSURER’s
actual MLR of eighty-two percent (82%) and the minimum MLR of eighty-five
percent (85%), and

    

    
      	
                                             
      

            	
              2)

            	
              one
      hundred percent (100%) of the difference between INSURER’s actual MLR and
      the Tier II maximum MLR of eighty-two percent
  (82%).

            

    

    

    INSURER
shall provide FHKC with a written copy of its findings for each Contract year by
April 1st.  If
any payments are due under this provision, INSURER shall forward such payment
within thirty (30) days of its written notification. 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.

    

    The
calculation shall be reported in a format approved by FHKC and FHKC may also
request supporting documentation. After receipt of INSURER’S submission, FHKC
may request that the calculation also be provided on a county by county
basis.

    

    INSURER’S
submission must include the following minimum information:

    

    Insurer
Name:

    Contract
Year:

    Counties
Included in Calculation:

    

    Total
Premiums Paid to INSURER during Contract Year: $

    Actual
Incurred Claims for Contract
Year:                                      $

    Medical
Loss Ratio
Achieved:                                                        %

    

    Apply
adjustment percentage in accordance with Section 3-21-3.

    

    Amount
Due to
FHKC:                                                                      $

    

    3-22         Premium
Rate Modifications

    

    INSURER
shall provide an actuarial memorandum to FHKC supporting any premium rate
adjustment requested under this section prior to any adjustment taking
effect.

    

    3-22-1     Annual
Adjustment Request

    

    Upon
request by INSURER, the Board of Directors of FHKC may approve an annual
adjustment to the premium rate. Prior to any submission deadline, FHKC will
provide INSURER with any trend information or other actuarial standards that may
be applied to any rate requests by FHKC’s consulting actuary during the review
process.

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
       

       

    

    
      Page 26
of 63

      
        

      

    

    
       

    

    Each
adjustment request must meet all of the following conditions:

    

    
      	
               
      

            	
              A.

            	
              Any
      request to adjust the premium rate for the upcoming Contract Year must be
      received by FHKC by April 1st
      (first).

            

    

    

    
      	
               
      

            	
              B.

            	
              INSURER’S
      request for an adjustment must be accompanied by a supporting actuarial
      memorandum which includes a breakdown of the rate utilizing the following
      categories:

            

    

    

    
      	 
      	 
      	
              Primary
      Care Physicians

            
	 
      	 
      	
              Specialty
      Care

            
	 
      	 
      	
              Hospital
      Inpatient

            
	 
      	 
      	
              Hospital
      Outpatient

            
	 
      	 
      	
              Pharmacy

            
	 
      	 
      	
              Durable
      Medical Equipment

            
	 
      	 
      	
              Behavioral
      Health

            
	 
      	 
      	
              Substance
      Abuse

            
	 
      	 
      	
              Other
      Services (Provide details)

            
	 
      	 
      	
              Administration

            

    

    

    
      	
               
      

            	
              C.

            	
              Any
      proposed premium rate adjustment must include all counties covered by the
      currently approved premium rate and be presented in the same format as
      submitted by INSURER under the ITN
process.

            

    

    

    
      	
               
      

            	
              D.

            	
              The
      proposed premium rate 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.

            

    

    

    
      	
               
      

            	
              E.

            	
              All
      approved rate adjustment requests under this Section are effective October
      1st through September 30th

            

    

    

    
      	
               
      

            	
              F.

            	
              Non-compliance
      with any reporting requirements under this Contract may result in the
      denial of a rate adjustment request submitted by INSURER at FHKC’s sole
      discretion, and such denial is not subject to the provisions of Section
      3-22-2.

            

    

    

    3-21-2     Annual
Premium Rate Adjustment Denials

    

    In the
event that INSURER’s annual premium rate adjustment is denied by the Board of
Directors of FHKC, and INSURER desires to appeal such decision, 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 premium rate must be submitted by 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 premium rate
request.

            

    

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
       

       

    

    
      Page 27
of 63

      
        

      

    

    
       

    

    
    

    

    
      	
               
      

            	
              B.

            	
              Within
      fourteen (14) calendar days of receipt of such request, FHKC shall provide
      INSURER with a list of three (3) qualified, independent actuaries and also
      provide the curriculum vitae for each proposed independent
      actuary.  INSURER shall select an independent actuary from the
      list provided by FHKC no later than fourteen (14) calendar days following
      receipt of all information from
FHKC.

            

    

    

    
      	
               
      

            	
              FHKC
      shall ensure that none of the three (3) qualified independent actuaries
      offered for selection has a working or personal relationship with FHKC’s
      contracted actuary. INSURER shall ensure that the actuary selected from
      the three (3) qualified, independent actuaries received from FHKC does not
      have a historical or current working relationship with INSURER or any
      working or personal relationship with an employee of INSURER or a
      Consultant/Contractor of INSURER involved in the course of this review or
      the original filing for a rate increase outside the scope of this
      project.

            

    

    

    
      	
               
      

            	
              C.

            	
              The
      Letter of Engagement will be executed by the selected independent actuary,
      FHKC and INSURER.

            

    

    

    
      	
               
      

            	
              D.

            	
              FHKC
      and INSURER are financially responsible for the fees incurred by the
      independent actuary for this dispute process and shall each pay fifty
      percent (50%) of the total costs.

            

    

    

    
      	
               
      

            	
              E.

            	
              All
      communications after execution of the Letter of Engagement and up through
      the submission of the final report by the independent actuary shall
      include both FHKC and INSURER, no communication may take place between the
      contracted independent actuary and just one (1) of the other
      parties.  If such communication takes place, the independent
      actuary will be disqualified and the Letter of Engagement terminated,
      immediately, and the review process begins again with a different
      independent actuary, pursuant to this
section.

            

    

    

    
      	
               
      

            	
              F.

            	
              The
      selected independent actuary will only review the original rate request as
      filed by INSURER, any reports developed by FHKC or FHKC’s consulting
      actuary and any supplemental communications regarding the proposed rate in
      existence prior to denial of the rate by the FHKC board of
      directors.  No new information may be considered during the
      review process, unless both FHKC and INSURER in writing agree to the
      provision of such information.

            

    

    

    
      	
               
      

            	
              G.

            	
              In
      conducting the review, the independent actuary
  may:

            

    

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
       

    

     

    
      Page 28
of 63

      
        

      

    

    
       

    

    

    
      	
               
      

            	
              1.

            	
              Uphold
      the rate requested by INSURER; or

            

    

    
      	
               
      

            	
              2.

            	
              Deny
      the rate requested by INSURER.

            

    

    

    If the
independent actuary denies the rate requested by the INSURER, the independent
actuary may recommend a revised rate.  In no event may the independent
actuary’s recommended rate be higher than the original rate requested by the
INSURER.

    

    Acceptance
of the revised rate is at the discretion of the FHKC Executive Director after
consulting with FHKC’s actuary.  If the revised rate is denied by the
Executive Director, the premium rate shall continue at the previous, most
recently approved rate.  INSURER may submit a written request for a
review of that determination at the next regularly scheduled meeting of the FHKC
Board of Directors following the Executive Director’s decision.

    

    
      	
               
      

            	
              H.

            	
              The
      independent actuary’s findings as described in Paragraph G of this Section
      must be in writing and communicated to both FHKC and INSURER within thirty
      (30) calendar days after execution of the Letter of Engagement by all
      parties.

            

    

    

    
      	
               
      

            	
              I.

            	
              The
      effective date of any premium rate adjustment based upon the actuary’s
      determination shall be October 1st
      (first) or the first of the month following receipt of the independent
      actuary’s findings, whichever occurs
first.

            

    

    

    
      	
               
      

            	
              J.

            	
              The
      findings of the independent actuary to either uphold or deny the rate will
      be binding.  However, if the independent actuary finds that the
      rate should be denied, then at the discretion of the Executive
      Director:

            

    

    

    
      	
               
      

            	
              1.

            	
              if
      the independent actuary provides a new recommended rate, the recommended
      revised rate may be implemented; or

            

    

    
      	
               
      

            	
              2..

            	
              The
      previous, most recently approved rate may be continued for the upcoming
      Contract Year.

            

    

    
      	
               
      

            	 

    

    3-21-3     Change
in Benefit Schedule

    

    
      	
               
      

            	
              INSURER
      understands that changes in federal and state law may require amendments
      to the Enrollee Benefit Schedule during the Contract
      term.  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 benefit
  schedule.

            

    

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
       

       

    

    
      Page 29
of 63

      
        

      

    

    
       

    

    
      	
               
      

            	
              If
      the change in the benefit schedule results in a reduction in a benefit
      level or increases in co-payments, FHKC may require that INSURER reduce
      its premium rate by an amount actuarially equivalent to the benefit
      reduction.

            

    

    

    If
benefits or co-payments are modified under this Section, INSURER may submit a
request for a rate adjustment to accommodate this modification. Final
determination of the INSURER’s compliance under this Section shall be made by
FHKC and shall not be subject to the provisions of Section 3-22-2.

    

    
      	
               
      

            	
               If
      INSURER elects not to implement the necessary change, FHKC may terminate
      this Contract by providing INSURER with a written notice of intent to
      terminate and include a termination date of not less than ninety (90) days
      from the date of the written notification or earlier if required by
      law.

            

    

    

    3-22-4     Specialty
Fee Arrangements

    

    
      	
               
      

            	
              FHKC
      shall have the right to negotiate specialty 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 rate, it will be adjusted by INSURER in a manner consistent with
      sound actuarial practices.

            

    

    

    3-23         Quality
Management

    

    3-23-1     Quality
Improvement Plans

    

    INSURER
shall have an ongoing Quality Improvement Plan (QIP) that objectively and
systematically monitors and evaluates the quality and appropriateness of care
and services rendered, thereby promoting Quality of Care and quality patient
outcomes in service performance to its Enrollees.  QIP’s must meet all
the requirements set forth under this Section.

    

    
      	
               
      

            	
              A.

            	
              INSURER
      shall develop and submit to FHKC a written QIP within thirty (30) calendar
      days from execution of the Contract and resubmit such plan by July 1st
      of each year for written approval.

            

    

    
      	
               
      

            	
              B.

            	
              INSURER’s
      written policies and procedures shall address components of effective
      health care management including, but not limited to, anticipation,
      identification, monitoring, measurement, evaluation of Enrollees’ health
      care needs, and effective action to promote quality of
    care.

            

    

    
      	
               
      

            	
              C.

            	
              INSURER
      shall define and implement improvements in processes that enhance clinical
      efficiency, provide effective utilization, and focus on improved outcome
      management achieving the highest-level of
  success.

            

    

    
      	
               
      

            	
              D.

            	
              INSURER’s
      QIP shall demonstrate in its care management, specific interventions to
      better manage the care and promote healthier Enrollee
      outcomes.

            

    

    
      	
               
      

            	
              E.

            	
              INSURER
      shall cooperate with FHKC and any external quality review organization or
      entity contracted with FHKC for such reviews.  FHKC 

                shall
      establish the methodology and standards for quality improvement that
      comply with any federal and state laws or
    regulations.

              

            

    

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
       

       

    

    
      Page 30
of 63

      
        

      

    

    
       

    

    
    

    3-23-2     Quality
Improvement Plan Committee

    

    INSURER
shall have a QIP Committee.  INSURER’s Medical Director shall serve as
either the Chairman or Co-chairman of the QIP Committee.  Other
Committee members shall be selected by INSURER but must include 1) the Quality
Director; 2) the Grievance Coordinator; 3) the utilization Review Manager; 4)
the Credentialing Manager; 5) the Risk Manager\Infection Control Profession (if
applicable); 6) Advocate Representation (if applicable); 7) Provider
Representation, either through providers serving on the Committee or through a
provider liaison position such as a representative from the network management
department.  The Committee shall meet on a regular periodic basis, no
less than quarterly.

    

    3-24         Records
Retention and Accessibility

    

    
      	
               
      

            	
              A.

            	
              INSURER
      agrees to maintain books, records and documents in accordance with
      generally acceptable accounting principles which sufficiently and properly
      reflect all expenditures of funds provided by FHKC under this
      Contract.

            

    

    

    
      	
               
      

            	
              B.

            	
              INSURER
      shall have all records used or produced in the course of the performance
      of this Contract available at all reasonable times for inspection, review,
      audit or copying to FHKC, any vendor contracted with FHKC or any state or
      federal regulatory agency as authorized by law or FHKC.  Access
      to such records will be during normal business hours and will be either
      through on-site review of records or through the mail. These records shall
      be retained for a period of at least five (5) years following the term of
      this Contract, except if an audit is in progress or audit findings are yet
      unresolved, in which case records shall be kept until all tasks are
      completed.

            

    

    

    
      	
               
      

            	
              C.

            	
              INSURER
      agrees to cooperate in any evaluative efforts conducted by FHKC or an
      authorized subcontractor of FHKC both during and for a period of at least
      five (5) years following the term of this Contract.  These
      efforts may include a post-Contract
audit.

            

    

    

    
      	
               
      

            	
              D.

            	
              Additionally,
      INSURER agrees to provide to FHKC, by July 1st
      (first) each year, an audited financial statement for INSURER’S preceding
      fiscal year.  If such is not customarily available in the
      ordinary course of INSURER’S business, then a written statement from an
      accountant verifying the financial stability of INSURER shall be submitted
      and be subject to the approval of the FHKC Board of
    Directors.

            

    

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
       

       

    

    
      Page 31
of 63

      
        

      

    

    
       

    

    
      	
               
      

            	
              E.

            	
              INSURER
      shall include all the requirements of this subsection in all approved
      subcontracts and assignments and INSURER agrees to require subcontractors
      and assignees to meet these
requirements.

            

    

    

    
      	
               
      

            	
              It
      is expressly understood that evidence of INSURER’S refusal to
      substantially comply with this provision or such failure by INSURER’S
      subcontractors, assignees or affiliates performing under this Contract
      shall constitute a material breach and renders this Contract subject to
      unilateral cancellation by FHKC.

            

    

    

    3-25         Refusal
of Coverage

    

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

    

    3-26         Regulatory
Filings

    

    INSURER
will forward all regulatory filings relating to this Contract to FHKC for its
review and approval. Once such regulatory filings are approved, FHKC will submit
such filings to the extent required by law or as desired by FHKC to the
Department of Financial Services or other appropriate regulatory entity on
INSURER’s behalf.

    

    3-27         Reporting
Requirements

    

    INSURER
shall comply with all reporting requirements under this Contract in the manner
and timeframes specified for each report and as listed under Attachment
E.

    

    INSURER
shall also provide quarterly encounter and claims data for all services rendered
under this Contract including any services provided by contracted Providers.
Such data shall be submitted on a quarterly basis utilizing a process and format
established by FHKC. FHKC may amend the process, format or requirements during
the Contract term and INSURER shall incorporate any such changes no later than
the third (3rd)
quarter’s report after notification of such changes by FHKC.

    

    INSURER
is responsible for guaranteeing that all subcontractors comply with these
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 Enrollee 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 permitted by law.

    

    The
timetable for the delivery of quarterly statistical reports is as
follows:

    

    
      	
              Encounters
      and Claims Processed During:

            	
              Claims
      Data Due to FHKC by:

            
	
              January
      1st
      – March 31st

            	
              April
      15th

            
	
              April
      1st
      – June 30th

            	
              July
      15th

            
	
              July
      1st
      – September 30th

            	
              October
      15th

            
	
              October
      1st
      – December 31st

            	
              January
      15th

            

    

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
       

    

     

    
      Page 32
of 63

      
        

      

    

    
       

    

    Failure
to provide these reports in a timely manner shall constitute a material breach
as defined under Section 4-18(C).

    

    INSURER
may be required to provide FHKC information or data that is not specified under
this Contract in order to comply with federal or state law or regulatory
requirements.  In such instances, and at the direction of FHKC,
INSURER shall fully cooperate with such requests and furnish all information in
a timely manner, in the format in which it is requested.  INSURER
shall have at least thirty (30) calendar days to fulfill such ad hoc reporting
requests.

    

    3-28         Subrogation
Rights

    

    In the
event INSURER provides medical services or benefits to Enrollees who suffer
injury, disease or illness by virtue of the negligent act or omission of a third
party, INSURER shall be entitled to seek reimbursement from the Enrollee or
third party, 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 Enrollee’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,
F.S. Nothing in this section as to coordination of benefits shall limit the
Enrollee’s right to receive direct health services under this
Contract.

    

    3-29         Termination
of Participation

    

    An
Enrollee’s coverage under this Program shall terminate on the last day of the
month in which the Enrollee:

    

    
      	
               
      

            	
              A.

            	
              Ceases
      to be eligible to participate in the
Program;

            

    

    

    
      	
               
      

            	
              B.

            	
              Establishes
      residence outside of the service area;
or

            

    

    

    
      	
               
      

            	
              C.

            	
              Is
      determined to have acted fraudulently as fraud is defined in this
      Contract.

            

    

    

    Termination
of coverage and the effective date of that termination shall by determined
solely by FHKC.

    

    3-30         Use
of Subcontractors or Affiliates

    

    INSURER
may contract with subcontractors or affiliates to deliver services under this
Contract subject to the following conditions.

    

    
      	
               
      

            	
              A.

            	
              INSURER
      identified the subcontractor or affiliate in its response to the ITN
      covered by this Contract.

            

    

    

    
      	
               
      

            	
              B.

            	
              INSURER
      has provided FHKC with a copy of the current contract or other written
      agreement and any amendments for services under this Contract between
      INSURER and the subcontractor or affiliate. FHKC shall have the right
      to withhold its approval of any such contracts, agreements and
      amendments.

            

    

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
       

       

    

    
      Page 33
of 63

      
        

      

    

    
       

    

    
    

    
      	
               
      

            	
              C.

            	
              INSURER’S
      Contract with the subcontractor or affiliate fully complies with all terms
      and conditions of this Contract between INSURER and
  FHKC.

            

    

    

    
      	
               
      

            	
              D.

            	
              INSURER
      agrees to provide FHKC with timely notice of termination of such
      agreements with any subcontractor or affiliate.  On a quarterly
      basis, INSURER shall provide FHKC with an attestation as to the adequacy
      of the INSURER’s network.

            

    

    

    
      	
               
      

            	
              E.

            	
              INSURER
      shall provide FHKC with timely notice of INSURER’S intent to contract with
      any new subcontractors or affiliates for services covered under this
      Contract.  Prior to execution, INSURER shall forward for FHKC’s
      review and approval any proposed agreement for services with
      subcontractors or affiliates.

            

    

    

    
      	
               
      

            	
              F.

            	
              By
      July 1st
      each year, INSURER agrees to provide FHKC with an annual report listing,
      for the previous calendar year, all subcontractors or affiliates that
      performed services under this Contract for
  INSURER.

            

    

    

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

    

    Failure
of INSURER to comply with the provisions of this section shall constitute a
material breach as provided under Section 4-18(C) of this Contract.

    

    3-31         Reimbursement
Requirements

    

    3-31-1     Out
of Network Providers

    

    Unless
otherwise provided for under this contract, where an Enrollee utilizes services
available under this contract other than emergency services from a non-contract
Provider, INSURER shall not be liable for the cost of such utilization unless
INSURER has referred the Enrollee t o the non-contract or out of network
Provider or authorized such out of network services.  INSURER shall
provide Enrollee with timely approval or denial of authorization of out of
network use through the assignment of a prior authorization number or other such
process as may be approved by FHKC.  Enrollee shall be liable for the
cost of such unauthorized use of contract-covered services from non-contract
providers.

    

    If
INSURER has granted prior authorization for out of network services that are
covered under this Contract or in the case of emergency services, INSURER is
responsible for the payment of claims incurred as a result of those
services.  Enrollee shall be responsible only for any applicable
co-payment as provided for under Attachment D.

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
       

       

    

    
      Page 34
of 63

      
        

      

    

    
       

    

    

    INSURER
shall also be responsible for any claims or costs incurred for services rendered
by out of network providers to Enrollees that have been directed by FHKC to seek
such services under Section 3-3.

    

    
      	
               
      

            	
              3-31-2

            	
              Reimbursement
      to Federally Qualified Health Centers and Rural Health
    Clinics

            

    

    

    As
required under the federal Children’s Health Insurance Program Re-Authorization
Act of 2009, to the extent that INSURER contracts for covered services with a
FQHC or RHC, INSURER shall reimburse such entities at an amount not less than
the reimbursement level provided under the Medicaid Prospective Payment System
for a FQHC or RHC.

    

    SECTION
4         GENERAL TERMS AND
CONDITIONS

    

    4-1           Amendment

    

    This
Contract may be amended by mutual written consent of the parties at any time.
This Contract shall automatically be amended to the extent necessary from time
to time to comply with state or federal laws or regulations or the requirements
of FHKC’s contract with the Agency for Health Care Administration (AHCA) upon
notice by FHKC to INSURER to that effect.

    

    4-2           Assignment

    

    This
Contract and the monies that may become due under it may not be assigned by
INSURER without the prior written consent of FHKC.  Any purported
assignment without such consent shall be deemed null and void.

    

    FHKC may
assign this Contract and the monies that may become due under it. Prior to any
such assignment, FHKC shall provide at least ninety (90) days written notice to
INSURER indicating its intention to assign the Contract. INSURER may elect to
terminate the Contract at the end of the next Contract term by providing written
notice to FHKC at least one-hundred and twenty (120) calendar days before the
end of the Contract term unless otherwise required by law.

    

    
      	
              4-3

            	
              Attachments

            

    

    

    Attachments
A through F are all incorporated into this Contract by reference.  In
any conflict between these Attachments and this Contract, the Contract provision
shall control.

    

    
      	
              4-4

            	
              Attorney
      Fees

            

    

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
       

       

    

    
      Page 35
of 63

      
        

      

    

    
       

    

     

    In the event of any legal action, dispute, litigation or other proceeding
with relation to this Contract, FHKC shall be entitled to recover from INSURER
its attorney fees and costs incurred, whether or not suit is filed, and if
filed, at both trial and appellate levels.  Legal
actions are defined to include administrative proceedings.  It is
understood that the intent of this provision is to protect the Enrollees who
receive health insurance benefits through the Program and rely upon the
continuation of the Program.

    

    4-5           Bankruptcy

    

    FHKC
shall have the absolute right to elect to continue or terminate this Contract,
at its sole discretion, in the event INSURER or any of its approved
subcontractors file a petition for bankruptcy or for approval of a plan of
reorganization or arrangement under the Bankruptcy Act. INSURER shall give FHKC
notice of the intent to petition for bankruptcy or reorganization or arrangement
at the time of the filing and immediately provide a copy of such filing to FHKC.
FHKC shall have thirty (30) calendar days upon receipt of such notice to elect
continuation or termination of this Contract.

    

    4-6           Change
of Controlling Interest

    

    FHKC
shall have the absolute right to elect to continue or terminate this Contract,
at its sole discretion, in the event of a change in the ownership or controlling
interest of INSURER or any of its approved subcontractors.  INSURER
shall give FHKC notice of regulatory agency approval, if applicable, prior to
any transfer or change in control. FHKC shall have thirty (30) calendar days to
elect continuation or termination of this Contract upon receipt of such
notice.

    

    4-7           Confidentiality

    

    INSURER
shall treat all information, particularly personal or identifying information
relating to Applicants or Enrollees that is obtained through its performance
under this Contract, as confidential information to the extent confidential
treatment is provided under state and federal laws including sections 624.91 and
409.821, F.S. regarding confidentiality of information held by FHKC and the
Florida KidCare Program.  INSURER shall not use any information
obtained in any manner except as necessary for the proper discharge of its
obligations and to secure its rights under this Contract.  Such
information shall not be divulged without written consent of FHKC, the Applicant
or the Enrollee.  This provision does not prohibit the disclosure of
information in summary, statistical or other form which does not identify
particular individuals.

    

    INSURER
and FHKC mutually agree to maintain the integrity of all proprietary information
to the extent provided under the law.  Neither party will disclose or
allow others to disclose proprietary information as determined by law by any
means to any person without 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.

    

    INSURER
understands that FHKC may be subject to the Florida Public Records Act, Section
119.07, F.S. and therefore all such information may be considered a public
record and open to inspection. Thus, unless otherwise confidential or exempted
by law, INSURER shall allow public access to all documents, papers, letters,
electronic correspondence or other material subject to the provisions of Chapter
119, F.S. and made or received by INSURER in conjunction with this
Contract.  However, INSURER agrees to advise FHKC prior to the release
of any such information.

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
       

       

    

    
      Page 36
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    4-8           Conflicts
of Interest; Non-Solicitation

    

    4-8-1       Conflicts
of Interest

    

    INSURER
confirms that to the best of its knowledge, the responsibilities and duties
assumed pursuant to this Contract are not in conflict with any other interest to
which INSURER is obligated or from which INSURER benefits.  Further,
INSURER agrees to inform FHKC immediately after becoming aware of any conflicts
of interest which it may have with the interests of FHKC, as set forth in this
Contract and which may occur in the future.

    

    Within
ten (10) days of contract execution, INSURER shall submit the attached
disclosure form identifying any relationships, financial or otherwise with any
FHKC Board Member, FHKC Ad Hoc Board Member or any employee of
FHKC.

    

    
      	
               
      

            	
              4-8-2

            	
              Gift
      Prohibitions

            

    

    

    In
accordance with FHKC Corporate Policies, INSURER affirms its understanding that
FHKC Board Members, FHKC Ad Hoc Board Members and FHKC Employees are prohibited
from accepting any gifts, including but not limited to, any meal, service or
item of value even de minimus from those entities that conduct or seek to
conduct business with FHKC.

    

    4-8-3       Non-Solicitation

    

    INSURER
recognizes and acknowledges that as a result of this Contract INSURER will come
into contact with employees of FHKC and that these employees have received
considerable training by FHKC.  INSURER agrees not to solicit, recruit
or hire any individual who is employed by FHKC during the term of this
Contract.  This prohibition shall be in effect for both the term of
this Contract and twelve (12) months immediately following its
termination.

    

    4-9           Effective
Dates

    

    
      	
               
      

            	
              1.

            	
              This
      Contract shall begin on October 1, 2009 (“Commencement
    Date”).

            

    

    

    
      	
               
      

            	
              2.

            	
              This
      Contract shall end on September 30,
2010.

            

    

    

    This
Contract may be extended at FHKC’s discretion for a maximum of two (2) one (1)
year additional periods beyond the initial term indicated above.  FHKC
agrees to notify INSURER by June 1, 2010, if FHKC does not intend to exercise
the first one (1) year extension option; and by June 1, 2011 if FHKC has the
prior extension and FHKC does not intend to exercise the final one (1) year
extension. In no event shall this contract extend beyond September 30,
2012.

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
       

       

    

    
      Page 37
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    FHKC may
exercise the renewal options of this Contract in whole or in part.

    

    Upon the
expiration of the Contract, should FHKC choose to use another vendor, INSURER
shall ensure a smooth transition.

    

    4-10         Entire
Understanding

    

    This
Contract with all Attachments incorporated by reference embodies the entire
understanding of the parties relating to the subject matter of this Contract,
and supersedes all other agreements, negotiations, understanding, or
representations, verbal or written, between the parties relative to the subject
matter hereof.

    

    4-11         Force
Majeure

    

    Neither
party shall be responsible for delays of failure in performance of its
obligations under this Contract resulting from acts beyond the control of the
party.  Such acts shall include, but are not limited to, blackouts,
riots, acts of war, terrorism, epidemics, government regulations on statutory
amendments adopted following the date of execution of this Contract, fire
communication line failure, computer hardware failure, computer executive
software failure, power failure or shortage, fuel shortages, hurricanes or other
natural disasters.

    

    4-12         Governing
Law; Venue

    

    This
Contract shall be governed by applicable state and federal laws and regulations
as such may be amended during the term of the Contract, whether or not expressly
included or referenced in this Contract.

    

    INSURER
agrees to comply with the following provisions as such may from time to time be
amended during the term of this Contract:

    

    
      	
               
      

            	
              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
      XI 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.

            

    

     

    
      
        	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

      

       

    

    
      Page 38
of 63

      
        

      

    

    
       

    

     

    
      
        	
                 
      

              	
                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
      American Disabilities Act of 1990, P.L. 101-336, which prohibits
      discrimination on the basis of disability and requires 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.

            

    

    

    
      	
               
      

            	
              H.

            	
              OMB
      Circular A-110 (Appendix A-4) which identifies procurement procedures
      which conform to applicable federal law and regulations with regard to
      debarment, suspension, ineligibility, and involuntary exclusion of
      contracts and subcontracts and as contained in Attachment A of this
      Contract.  Covered transactions include procurement contracts
      for services equal to or in excess of one hundred thousand dollars
      ($100,000.00) and all non-procurement
  transactions.

            

    

    

    I.         
   Title XXI of the federal Social Security Act.

    

    J.            
All applicable state and federal laws and regulations governing
FHKC.

    

    
      	
               
      

            	
              K.

            	
              All
      regulations, guidelines and standards as are now or may be lawfully
      adopted under the above statutes.

            

    

    

    INSURER
agrees that compliance with this assurance constitutes a condition of continued
receipt of or benefit from funds provided through this Contract and such
compliance is binding upon INSURER, its successors, transferees and assignees
for the period during which services are provided.  INSURER further
agrees that all contractors, subcontractors, subgrantees or others with whom it
arranges to provide goods, services or benefits in connection with any of its
programs and activities are not discriminating against either those whom they
employ nor those to whom they provide goods, services or benefits in violation
of the above statutes, regulations, guidelines and standards.

    

    It is
expressly understood that evidence of INSURER’S refusal or failure to
substantially comply with this section or such failure by INSURER’S
subcontractors or anyone with whom INSURER affiliates in performing under this
Contract shall constitute a material breach and renders this Contract subject to
unilateral cancellation by FHKC.

    

    Any legal
action with respect to the provisions of this Contract shall be brought in
federal or state court in Leon County, Florida.

    

    4-13         Independent
Contractor

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
       

       

    

    
      Page 39
of 63

      
        

      

    

    
       

    

    The
relationship of INSURER to FHKC shall be solely that of an independent
contractor.  The parties acknowledge and agree that neither party has
the authority to make any representation, warranty or binding commitment on
behalf of the other party, except as expressly provided in this Contract or as
otherwise agreed to in writing by the parties, and nothing contained in this
Contract shall be deemed or construed to (i) create a partnership or joint
venture between the parties or any affiliate, employee or agent of a party; or
(ii) constitute any party or any employee or agent of a party as an employee or
agent of the other party.

    

    4-14         Name
and Address of Payee

    

    The name
and address of the official payee to whom the payment shall be
made:

    

    For
INSURER:       WellCare of Florida,
Inc.

    Name:                     Robert
Diaz, Vice President, Regulatory Affairs and Quality

    Assurance

    Address:              
 5404 Cypress Center Drive, Suite 300, Tampa, FL 33609

    Email:                      robert.diaz@wellcare.com

    

    4-15         Notice
and Contact

    

    All
notices required under this section shall be in writing and may be delivered by
certified mail with return receipt requested, by facsimile with proof of
receipt, by electronic mail with proof of receipt or in person with proof of
delivery.

    

    Notice
required or permitted under this Contract shall be directed as
follows:

    

    For
FHKC:

    Jennifer
Kiser Lloyd

    Florida
Healthy Kids Corporation

    661 East
Jefferson Street, 2nd
Floor

    Tallahassee,
FL 32301

    (850)
224-5437 (Phone)

    (850)
224-0615 (Fax)

    lloydj@healthykids.org

    

    For
INSURER:       Wellcare of Florida,
Inc.

    Name:                     Robert
Diaz, Vice President, Regulatory Affairs and Quality

    Assurance

    Address:             
  5404 Cypress Center Drive, Suite 300, Tampa, FL 33609

    Email:                  
   robert.diaz@wellcare.com

    

    In the
event that different contact persons are designated by either party after
execution of this Contract, notice of the name and address of the new contact
will be sent to the other party and be attached to the originals of this
Contract.

    

    4-16         Severability

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
       

       

    

    
      Page 40
of 63

      
        

      

    

    
       

    

     

    If any of
the provisions of this Contract are held to be inoperative by a court of
competent jurisdiction, such a provision shall be severed from the remaining
provisions of the Contract which shall remain in full force and
effect.

    

    
      	
              4-17

            	
              Survival

            

    

    

    The
provisions of the following sections: Records Retention and Accessibility;
Attorney Fees; Confidentiality; Conflicts of Interest; Non-Solicitation and
Governing Law; Venue shall survive any termination of this
Contract.

    

    4-18         Termination
of Contract

    

    A.       
    Termination for Lack of Funding

    

    This
Contract is subject to the continuation and approval of funding to FHKC from
state, federal and other sources.  FHKC shall have the absolute right,
in its sole discretion, to terminate this Contract if funding for the Program is
to be changed or terminated such that this Contract should not be
sustained.  FHKC shall send INSURER notice of termination and include
a termination date of not less than thirty (30) calendar days from the date of
the notice.

    

    
      	
               
      

            	
              B.

            	
              Termination
      for Lack of Payment or Performance

            

    

    

    If FHKC
fails to make payments in accordance with the schedule included in this
Contract, INSURER may suspend work and pursue the appropriate remedies for
FHKC’s breach of its payment obligations. INSURER must provide FHKC at
least thirty (30) calendar days written notice of any suspension due to lack of
payment and allow FHKC an opportunity to correct the default prior to suspension
of work.

    

    If
INSURER fails to make timely progress on the objectives of this Contract or
fails to meet the deliverables described under this Contract in the time and
manner prescribed, FHKC may terminate this Contract on not less than thirty (30)
calendar days notice either in whole or in part.  At its discretion,
FHKC may allow INSURER to cure any performance deficiencies prior to final
termination.

    

    C.            
   Termination for Material Breach

    

    In the
event INSURER materially breaches this
Contract, FHKC shall give INSURER notice of such breach
and INSURER shall
have thirty (30) calendar days from receipt of this notice to cure the breach or
at FHKC’s sole discretion, permit the INSURER to submit a corrective action to
cure the breach.

    

    If the
breach is not cured to the satisfaction of FHKC and FHKC elects to terminate
this agreement either in whole or in part, the notice of termination shall be
sent in accordance with the notification requirements of this Contract. The
notice of termination shall specify the nature of the termination, the extent to
which performance of work under the Contract is termination and the date on
which such termination shall become effective.  The notice of
termination shall specify the nature of the termination, the extent to which
performance of work under the Contract is terminated, and the date on which such
termination shall become effective. FHKC may terminate this Contract upon no
less than twenty-four (24) hours notice.

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
       

       

    

    
      Page 41
of 63

      
        

      

    

    
       

    

    Waiver of
breach of any provision of this Contract shall not be deemed to be a waiver of
any other breach and shall not be construed to be a modification of the terms of
this Contract.

    

    D.        
   Termination upon Revision of Applicable Law

    

    FHKC and
INSURER agree if federal or state revisions of any applicable laws or
regulations restrict FHKC’s ability to comply with the Contract, make such
compliance impracticable, frustrate the purpose of the Contract or place the
Contract in conflict with FHKC’s ability to adhere to its statutory purpose,
FHKC may unilaterally terminate this Contract.  FHKC shall send
INSURER notice of termination and include a termination date of not less than
thirty (30) calendar days from the date of notice.

    

    E.          
  Termination by FHKC

    

    Notwithstanding
any other termination provisions, FHKC may terminate this Agreement or any part
of this Agreement, without penalty or cost to FHKC, at its convenience, and such
termination will be effective at such time as is determined by
FHKC.

    

    TWO
(2) SIGNATURE PAGES FOLLOW

    

    THE
REMAINDER OF THIS PAGE LEFT INTENTIONALLY BLANK

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
       

       

    

    
      Page 42
of 63

      
        

      

    

    
       

    

    

    IN
WITNESS WHEREOF, the parties have caused this Contract, to be
executed

    by their
undersigned officials as duly authorized.

    

    FOR

    HealthEase
of Florida, Inc.

    

    
      

       

    

    
       

      
        	/s/ Heath
  Schiesser

      

      PRINTED NAME OF SIGNATURE
ABOVE:  Heath
Schiesser

    

    TITLE:     President & CEO

    DATE
SIGNED: 29 September 2009

    

    STATE OF
FLORIDA          )

    

    COUNTY OF
Hillsborough )

     

    

    The
foregoing instrument was acknowledged me before this 29   day of
          September                 ,
2009, by _Heath
Schiesser            ,
as       President
and CEO      on behalf of HealthEase of Florida,
Inc..  He/She is personally known to
me or has produced ________________ as identification.

    

    

     

    
      	/s/ Erika
      Lema     	 	 
	 Notary
      Public	 	 [notary
      stamp]
	 	 	 
	 11/18/09	 	 
	My Commission
      Expires	 	 

    

     

    
      
        
           

          
            	/s/ Michele L.
  Booth

          

          WITNESS #1 SIGNATURE

           

        

      

      
        
          	Michele L.
Booth

        

        WITNESS #1 PRINT NAME

      

    

     

    
      

      
        
          	/s/ Karen
Mulroe

        

        WITNESS #2 SIGNATURE

         

         

        
          
            	Karen
Mulroe

          

          WITNESS #2 PRINT NAME

        

         

      

    

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
      
        
        

      

      
        Page 43
of 63

        
          

        

      

      
        
        

      

    

     

    FOR

    WellCare
of Florida, Inc./Staywell Health Plan of Florida

     

     

    
       

      
        
          	/s/ Heath
  Schiesser

        

        PRINTED NAME OF SIGNATURE
ABOVE:  Heath
Schiesser

      

      TITLE:     President & CEO

      DATE
SIGNED: 29 September
2009

    

     

    STATE OF
FLORIDA          )

    

    COUNTY OF
Hillsborough )

     

    

    The
foregoing instrument was acknowledged me before this 29   day of
          September                 ,
2009, by _Heath
Schiesser            ,
as       President
and CEO      on behalf of WellCare of
Florida, Inc..  He/She is personally known to
me or has produced ________________ as identification.

     

    
      

       

      
        	/s/ Erika
      Lema     	 	 
	 Notary
      Public	 	 [notary
      stamp]
	 	 	 
	 11/18/09	 	 
	My Commission
      Expires	 	 

      

       

      
        
          
             

            
              	/s/ Michele L.
  Booth

            

            WITNESS #1 SIGNATURE

             

             

          

        

        
          
            	Michele L.
Booth

          

          WITNESS #1 PRINT NAME

        

      

       

      
        

        
          
            	/s/ Karen
Mulroe

          

          WITNESS #2 SIGNATURE

           

           

          
            
              	Karen
Mulroe

            

            WITNESS #2 PRINT NAME

          

        

      

    

     

    
      	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

    

    
       

       

    

    
      Page 44
of 63

      
        

      

    

    
       

    

    FOR

    FLORIDA
HEALTHY KIDS CORPORATION:

    

     

    
      
         

        
          
            	/s/ Rich
  Robleto

          

          NAME:   Rich Robleto

        

        TITLE:   Executive
Director

      

      DATE
SIGNED: 

      

    

    

    STATE OF
FLORIDA    )

     

    COUNTY OF
Leon       
 )

    

    

    The
foregoing instrument was acknowledged me before this 28th day of August, 2009, by
Rich Robleto,
as Executive
Director on behalf of FHKC.  He/She is personally known to
me or has produced ________________ as identification.

    

    
       

       

      
        	/s/ Amber N.
      Floyd	 	 
	 Notary
      Public	 	 [notary
      stamp]
	 	 	 
	 November 14,
      2009	 	 
	My Commission
      Expires	 	 

      

       

       

       

      
        
          
            
              
                	/s/ Amber N. Floyd
	WITNESS #1
      SIGNATURE 

              

               

               

               

            

          

          
            
              	Amber N. Floyd
	WITNESS #1 PRINT
      NAME

            

             

          

        

        
          
          

          
            

            
              
                	/s/ Gladys Medrano
	WITNESS #2
      SIGNATURE 

              

               

               

               

              
                
                  	Gladys Medrano
	WITNESS #2 PRINT
      NAME 

                

                 

              

            

          

           

          Reviewed
by:

          
          

           

          
            	 /s/ Jennifer
      K. Lloyd	 Date:  8/21/2009	 	 

          

          Signature of: Jennifer K.
Lloyd

        

      

      Chief
External Affairs Officer

       

      
         

        
          	/s/ Joan Humphrey
      Anderson 	 Date:  8/26/2009	 	 

Printed
Name: Joan Humphrey Anderson

      

      FHKC
General Counsel

      Florida
Bar Number: 0294063

       

      
        	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

      

      
        
          
          

        

        
          Page 45
of 63

          
            

          

        

        
          
          

        

      

       

      
        	
                ATTACHMENT
      A

                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
      entity whose contract\subcontract equals or exceeds twenty five thousand
      dollars ($25,000) in federal monies must sign this certification prior to
      execution of each contract\subcontract.  Additionally, entities
      who audit federal programs must also sign, regardless of the contract
      amount. The Florida Healthy Kids Corporation cannot contract with these
      types of Entities 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.

              	
                INSURER
      shall provide immediate written notice to the contract manager at any time
      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.

              	
                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.

              	
                INSURER
      further agrees by submitting this certification that it will require each
      subcontractor of this contract/subcontract whose payment will equal or
      exceed twenty five thousand dollars ($25,000) in federal monies, to submit
      a signed copy of this
certification.

              

      

       

      
        	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

      

      
         

         

      

      
        Page 46
of 63

        
          

        

      

      
         

      

      

      
        	
                G.

              	
                The
      Florida Healthy Kids Corporation may rely upon a certification of INSURER
      that it is not debarred, suspended, ineligible, or voluntarily excluded
      from contracting\subcontracting 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

      

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

      

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

      

      

      

      

      /s/ Heath
Schiesser                                                                                 29
September
2009                           

      Printed
Name of Signature
Above: Heath Schiesser                          Date
Signed

       

      Title:
President & CEO

      

      

      REMAINDER
OF THIS PAGE LEFT INTENTIONALLY BLANK

       

      
        	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

      

      
         

         

      

      
        Page 47
of 63

        
          

        

      

      
         

      

      

      
        	
                ATTACHMENT
      B

                CERTIFICATION
      REGARDING LOBBYING

                CERTIFICATION
      FOR CONTRACTS, GRANTS, LOANS AND COOPERATIVE
  CONTRACTS

              

      

       

      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 Contract and the extension, continuation, renewal, amendment
      or modification of any federal contract, grant, loan or cooperative
      Contract.

              

      

       

      
        	
                (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 Contract, 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
      Contracts) 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 ten thousand dollars ($10,000.00) and not more than one hundred
thousand dollars ($100,000.00) for each such failure.

      

      

      

      /s/ Heath
Schiesser                                                                                 29 September
2009                          
 

      Printed
Name of Signature
Above: Heath Schiesser                         Date
Signed

       

      Title:
President & CEO

      

      
        	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

      
        
          
          

        

        
          Page 48
of 63

          
            

          

        

        
          
          

        

      

       

      
        	
                ATTACHMENT
      C

                REGARDING HEALTH INSURANCE
      PORTABILITY AND ACCOUNTABILITY ACT OF 1996 COMPLIANCE:

                BUSINESS
      ASSOCIATE (BA) AGREEMENT

              

      

      

      THIS BA
AGREEMENT (Attachment C), is entered into and made between Florida Healthy Kids
Corporation, a Florida non-profit corporation, (FHKC) (the “Covered Entity”) and
INSURER (the “BA”) and is incorporated in the Services Contract (Contract)
between FHKC and INSURER.

      

      
        	
                1.

              	
                HIPAA
      Compliance.  FHKC and BA agree to comply with the Health
      Insurance Portability and Accountability Act of 1996, Pub. L. No. 104-191,
      as amended from time to time (“HIPAA”).  Pursuant to HIPAA, FHKC
      meets the definition of a covered entity and BA meets the definition as a
      business associate.  As a covered entity, FHKC must obtain and
      document satisfactory assurances from business associates, such as BA,
      that BA shall appropriately safeguard the individually identifiable health
      information which is personal health information (“PHI”) and/or electronic
      protected health information (“EPHI”) though a written contract or other
      written agreement such as this
Attachment.

              

      

      

      
        	
                2.

              	
                Definitions
      For Use in This Attachment.  Terms used, but not otherwise
      defined, in this Attachment and the Contract shall have the same meaning
      as those terms in 45 C.F.R. Parts 160, 162 and
  164.

              

      

      

      
        	
                3.

              	
                Privacy
      Obligations and Activities of BA.  BA shall ensure compliance
      with the HIPAA Standards for Privacy of Individually Identifiable Health
      Information, 45 C.F.R. Part 160 and Part 164 (the “Privacy
      Rule”).  Without limiting the generality of the foregoing, BA
      agrees that it will, in accordance with HIPAA, comply with the
      following:

              

      

      
        	
                 
      

              	
                BA
      agrees to not use or disclose personal health information PHI other than
      as permitted or required by this Attachment, the Contract or as Required
      By Law.

              

      

      
        	
                 
      

              	
                BA
      agrees to use appropriate safeguards to prevent use or disclosure of PHI
      other than as provided for by this Attachment and the
      Contract.

              

      

      
        	
                 
      

              	
                BA
      shall implement administrative, physical, and technical safeguards that
      reasonably and appropriately protect the confidentiality, integrity, and
      availability of EPHI that it 

                         
      creates, receives, maintains or transmits on behalf of the Covered
      Entity.

              

      

      
        	
                 
      

              	
                BA
      agrees to mitigate, to the extent practicable, any harmful effect that is
      known to BA of a use or disclosure of PHI by BA in violation of the
      requirements of this Attachment, 

                         
      the Contract and HIPAA.

              

      

      
        	
                 
      

              	
                BA
      agrees to report to Covered Entity any use or disclosure of PHI not
      provided for by this Attachment and the Contract of which it becomes
      aware, within twenty (20) 

                         
      business days.

              

      

      
        	
                 
      

              	
                BA
      shall promptly report to Covered Entity any “security incident” of which
      it becomes aware; as such term is defined in the HIPAA Security
      Rule.  At the request of Covered 

                         
      Entity, BA shall identify: the date of the security incident, the scope of
      the security incident, the BA’s response to the security
      incident and the identification of the party 

                         
      responsible for causing the security incident, if
      known.

              

      

       

      
        	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

      

      
         

         

      

      
        Page 49
of 63

        
          

        

      

      
         

      

      
      

      
        	
                 
      

              	
                BA
      agrees to ensure that any agent, including a subcontractor, to whom it
      provides PHI and/or EPHI received from, or created or received by BA on
      behalf of Covered Entity, 

                         
      agrees to the same restrictions and conditions that apply through this
      Attachment and the Contract to BA with respect to such
      information.

              

      

      
        	
                 
      

              	
                BA
      agrees to provide access, at the written request of Covered Entity, within
      ten (10) business days of the written request (five (5) additional
      business days are permitted if 

                         
      written request provided by the U.S. Postal Service (“USPS”)), to PHI in a
      Designated Record Set (“DRS”), to Covered Entity or, as directed by
      Covered Entity, to an 

                         
      Individual in order to meet the requirements under 45 CFR
      §164.524.  In the event any Individual requests access to PHI
      directly from BA, BA shall forward written notice 

                         
      of such request, to Covered Entity within ten business (10) days (five (5)
      additional business days are permitted if written notice provided by
      U.S.P.S.).  Any denials of 

                         
      access to the PHI requested shall be the responsibility of Covered
      Entity.

              

      

      
        	
                 
      

              	
                BA
      agrees to make any amendment(s) to PHI in a DRS that the Covered Entity
      directs or agrees to pursuant to 45 CFR §164.526 at the written request of
      Covered Entity or an 

                         
      Individual, within twenty (20) business days of the written request (five
      (5) additional business days are permitted if written request provided by
      U.S.P.S.).

              

      

      
        	
                 
      

              	
                BA
      agrees to make internal practices, books, and records, including policies
      and procedures and PHI, relating to the use and disclosure of PHI received
      from, or created or 

                         
      received by BA on behalf of, Covered Entity available to the Covered
      Entity and to the Secretary, within fifteen (15) business days notice of
      the Secretary’s request (five 

                         
      (5) additional business days permitted if notice provided by U.S.P.S.) or
      in the time and manner designated by the Secretary, for purposes of the
      Secretary determining 

                         
      Covered Entity's HIPAA compliance.

              

      

      
        	
                 
      

              	
                BA
      agrees to document such disclosures of PHI and information related to such
      disclosures as would be required for Covered Entity to respond to a
      request by an Individual 

                         
      for an accounting of disclosures of PHI in accordance with 45 CFR
      §164.528.

              

      

      
        	
                 
      

              	
                BA
      agrees to provide to Covered Entity, or an Individual at the request of
      the Covered Entity, within fifteen (15) business days (five (5) additional
      business days are permitted 

                         
      if written notice provided by U.S.P.S.) of written notice by Covered
      Entity to BA that Covered Entity has received a request for an accounting
      of PHI disclosures 

                         
      regarding an Individual during the six (6) years prior to the date on
      which the accounting was requested, information collected in accordance
      with Section 2.i. of this 

                         
      Attachment, to permit Covered Entity to respond to a request by an
      Individual for an accounting of disclosures, pursuant to 45 CFR
      §164.528.

              

      

       

      
        	
                4.

              	
                Security.  BA
      shall ensure compliance with the HIPAA Security Standards for the
      Protection of Electronic Protected Health Information (“EPHI”), 45 C.F.R.
      Part 160 and Part 164, Subparts A and C (the “Security Rule”), with
      respect to Electronic
      Protected Health Information covered by this Contract effective on the
      compliance date for initial implementation of the security standards set
      for in 45 C.F.R. §164.318. Without limiting the generality of the
      foregoing, BA agrees that it will, in accordance with
      HIPAA:

              

      

       

      
        	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

      

      
         

         

      

      
        Page 50
of 63

        
          

        

      

      
         

      

      
      

      
        	
                 
      

              	
                Implement
      administrative, physical, and technical safeguards that reasonably and
      appropriately protect the confidentiality, integrity, and availability of
      the Electronic Protected 

                         
      Health Information that it creates, receives, maintains, or transmits on
      behalf of Covered Entity as required by 45 C.F.R. Part 164, Subpart
      C.

              

      

      
        	
                 
      

              	
                Ensure
      that any agent, including a subcontractor, to whom it provides such
      information, agrees to implement reasonable and appropriate safeguards to
      protect it;

              

      

      
        	
                 
      

              	
                Report
      to the Covered Entity any security incident of which it becomes
      aware;

              

      

      
        	
                 
      

              	
                Ensure
      the confidentiality, integrity, and availability of all Electronic
      Protected Health it creates, receives, maintains, or
      transmits;

              

      

      
        	
                 
      

              	
                Protect
      against any reasonably anticipate threats or hazards to the security or
      integrity of such information;

              

      

      
        	
                 
      

              	
                Protect
      against any reasonably anticipated uses or disclosures of such information
      that are not permitted or required under HIPAA;
  and

              

      

      
        	
                 
      

              	
                Ensure
      compliance with 45 C.F.R. Part 164, Subpart C (Security Standards for the
      Protection of Electronic Protected health Information) by its
      workforce.

              

      

       

      
        	
                5.

              	
                Electronic
      Transaction And Code Sets.  BA shall comply with the HIPAA
      Standards for Electronic Transactions and Code Sets, 45 C.F.R. Parts 160
      and 162, with respect to Electronic Protected Health Information covered
      by this Contract.  Without limiting the generality of the
      foregoing, BA agrees that it will, in accordance with 45 C.F.R. §
      162.923(c):

              

      

      
        	
                 
      

              	
                Comply
      with all applicable requirements of 45 C.F.R. Part 162;
  and

              

      

      
        	
                 
      

              	
                Require
      any agent or subcontractor to comply with all applicable requirements of
      45 C.F.R. Part 162.

              

      

       

      
        	
                6.

              	
                Permitted
      Uses and Disclosures by BA - General Use and Disclosure
      Provisions.  Except as otherwise limited in this Attachment, BA
      may use or disclose PHI to perform functions, activities, or services for,
      or on behalf of, Covered Entity as specified in the Contract, provided
      that such use or disclosure would not violate HIPAA if done by Covered
      Entity or the minimum necessary policies and procedures of Covered
      Entity.

              

      

      

      
        	
                7.

              	
                Permitted
      Uses and Disclosures by BA - Specific Use and Disclosure
      Provisions.

              

      

      
        	
                 
      

              	
                Except
      as otherwise limited in this Attachment and the Contract, BA may use PHI
      for the proper management and administration of BA or to carry out BA’s
      legal 

                         
      responsibilities.

              

      

      
        	
                 
      

              	
                Except
      as otherwise limited in this Attachment and the Contract, BA may disclose
      PHI for the BA’s proper management and administration, provided that
      disclosures are 

                         
      Required By Law, or BA obtains reasonable assurances from the person to
      whom the information is disclosed that the information will remain
      confidential and used or 

                         
      further disclosed only as Required By Law or for the purpose for which it
      was disclosed to the person,
      and the person notifies BA of any instances of which it is aware in
      

                         
      which the confidentiality of the information has been
      breached.

              

      

       

      
        	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

      

      
         

         

      

      
        Page 51
of 63

        
          

        

      

      
         

      

      
      

      
        	
                 
      

              	
                Except
      as otherwise limited in this Attachment and the Contract, BA may use PHI
      to provide Data Aggregation services to Covered Entity as permitted by 42
      C.F.R. §164.504(e)(2)(i)(B).

              

      

      
        	
                 
      

              	
                BA
      may use PHI to report violations of law to appropriate Federal and State
      authorities, consistent with 42 C.F.R.
  §164.502(j)(1).

              

      

       

      
        	
                8.

              	
                Provisions
      for Covered Entity to Inform BA of Privacy Practices and
      Restrictions.

              

      

      
        	
                 
      

              	
                Covered
      Entity shall notify BA of any limitation(s) in its notice of privacy
      practices of Covered Entity in accordance with 45 CFR §164.520, to the
      extent that such limitation may 

                         
      affect BA's use or disclosure of
PHI.

              

      

      
        	
                 
      

              	
                Covered
      Entity shall notify BA of any changes in, or revocation of, permission by
      Individual to use or disclose PHI, to the extent that such changes may
      affect BA's use or 

                         
      disclosure PHI.

              

      

      
        	
                 
      

              	
                Covered
      Entity shall notify BA of any restriction to the use or disclosure of PHI
      that Covered Entity has agreed to in accordance with 45 CFR §164.522, to
      the extent that such 

                         
      restriction may affect BA's use or disclosure of
  PHI.

              

      

       

      
        	
                9.

              	
                Term
      and Termination.

              

      

      
        	
                 
      

              	
                Term.  The
      Term of this Attachment shall be effective concurrent with the Contract,
      and shall terminate when all of the PHI provided by Covered Entity to BA,
      or created or 

                         
      received by BA on behalf of Covered Entity, is destroyed or returned to
      Covered Entity, or, if it is infeasible to return or destroy PHI,
      protections are extended to such 

                         
      information, in accordance with the termination provisions in this
      Section.

              

      

      
        	
                 
      

              	
                Termination
      for Cause. Upon Covered Entity's knowledge of a material breach by BA,
      Covered Entity shall either:

              

      

      
        	
                 
      

              	
                Provide
      an opportunity for BA to cure the breach or end the violation and
      terminate this Attachment and/or the Contract if BA does not cure the
      breach or end the 

                         
      violation within thirty (30) calendar days (five (5) additional calendar
      days are permitted if written notice provided by U.S.P.S.) of Covered
      Entity’s notice to BA of 

                         
      the Covered Entity knowledge of the BA’s material breech;
    or

              

      

      
        	
                 
      

              	
                Immediately
      terminate this Attachment and the Contract if BA has breached a material
      term of this Attachment and/or the Contract and cure is not possible; as
      determined 

                         
      at the sole discretion of Covered Entity;
or

              

      

      
        	
                 
      

              	
                If
      neither termination nor cure is feasible, Covered Entity shall report the
      violation to the Secretary.

              

      

      
        	
                 
      

              	
                Effect
      of Termination.

              

      

      
        	
                 
      

              	
                Except
      as provided in paragraph (ii) of this Section, upon termination of this
      Attachment and the Contract, for any reason, BA shall return or destroy
      all PHI received from 

                         
      Covered Entity, or created or received by BA on behalf of Covered
      Entity.  This provision shall apply to PHI that is in the
      possession of any subcontractors or 

                         
      agents of BA, and BA has the duty to insure that any of its 

                         
      subcontractors or agents complies with these termination
      provisions.  Neither BA, nor any of its subcontractors or
      agents, shall retain any copies of PHI upon 

                         
      termination of this Attachment and the
Contract.

              

      

       

      
        	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

      

      
         

         

      

      
        Page 52
of 63

        
          

        

      

      
         

      

      
      

      
        	
                 
      

              	
                In
      the event that BA determines that returning or destroying the PHI is
      infeasible, BA shall provide to Covered Entity written notification of the
      conditions that make 

                          return
      or destruction infeasible thirty (30) calendar days (five (5) additional
      calendar days are permitted if written notice provided by U.S.P.S.) prior
      to the 

                         
      termination of
      the Contract or within thirty (30) calendar days (five (5) additional
      calendar days are permitted if written notice provided by U.S.P.S.) of
      BA’s notice of 

                         
      Covered Entity’s knowledge of a material breach of this Attachment and/or
      the Contract.  Upon mutual agreement of the parties that return
      or destruction of PHI is 

                         
      infeasible; BA shall extend the protections of this Attachment and the
      Contract such PHI and limit further uses and disclosures of such PHI to
      those purposes that 

                         
      make the return or destruction infeasible, for so long as BA maintains
      such PHI.

              

      

      
        	
                10.

              	
                Miscellaneous.

              

      

      
        	
                 
      

              	
                Regulatory
      References. A reference in this Attachment and the Contract to a section
      in HIPAA means the section as in effect or as
  amended.

              

      

      
        	
                 
      

              	
                Amendment.
      The parties agree to take such action as is necessary to amend this
      Attachment and the Contract, from time to time, as is necessary for
      Covered Entity to comply 

                         
      with the requirements of HIPAA.

              

      

      
        	
                 
      

              	
                Survival.
      The respective rights and obligations of BA under Section 9.c., “Effect of
      Termination,” of this Attachment shall survive the termination of this
      Attachment and the 

                         
      Contract.

              

      

      
        	
                 
      

              	
                Interpretation.
      Any ambiguity in this Attachment and the Contract shall be resolved to
      permit Covered Entity to comply with
HIPAA.

              

      

      

      ONE
(1) HIPAA BA SIGNATURE PAGES FOLLOW

      

      THE
REMAINDER OF THIS PAGE LEFT INTENTIONALLY BLANK

       

      
        	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

      

      
         

         

      

      
        Page 53
of 63

        
          

        

      

      
         

      

      

      IN
WITNESS WHEREOF, the arties have caused this Attachment C, BA AGREEMENT, to be
executed by their undersigned officials as duly authorized.

      

      

      FOR

      HEALTHEASE
OF FLORIDA, INC.:

       

       

       

      
        	/s/ Heath
      Schiesser

      

      PRINTED
NAME OF SIGNATURE ABOVE:  Heath Schiesser

      TITLE:   President
& CEO

      DATE
SIGNED:  29 September 2009

       

      
 

      

      FOR

      Wellcare
of Florida, inc.

       

       

       

      
        
          	/s/ Heath
      Schiesser

        

        PRINTED
NAME OF SIGNATURE ABOVE:  Heath Schiesser

        TITLE:   President
& CEO

        DATE
SIGNED:  29 September 2009

      
         

      

      

      

      FOR

      FLORIDA
HEALTHY KIDS CORPORATION:

      

      

      
        
          	/s/ Rich
      Robleto

        

      

      NAME:                                Rich
Robleto

      TITLE:                                Executive
Director

      DATE
SIGNED:

      

      

      
        	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

      

      
         

         

      

      
        Page 54
of 63

        
          

        

      

      
         

      

      ATTACHMENT
D – ENROLLEE BENEFIT SCHEDULE

      

      
        	
                 
      

              	
                I.

              	
                Minimum
      Enrollee Benefits Schedule

              

      

       

      INSURER
agrees to provide, at a minimum, those benefits that are prescribed by state law
for the Program.  If INSURER requires clarification of any coverage or
co-payment requirements, INSURER shall consult with FHKC to confirm coverage
requirements.

       

      INSURER
shall pay an Enrollee’s covered expenses up to a lifetime maximum of one million
dollars ($1,000,000.00) per covered Enrollee.

       

      II.      Health
Care Benefits

       

      The
following health care benefits are included under this Contract:

       

      

      
        
          	
                  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 395.

                  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 fifteen (15) days
      per contract year.

                  Shall
      not include experimental or investigational procedures 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. Food and Drug Administration or the Department of Health and Human
      Services.

                	
                  NONE

                

        

         

        
          	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

        

        
          
            
            

          

          
            Page 55
of 63

            
              

            

          

          
            
            

          

        

         

        
          

          
            
              	
                      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 Enrollee’s health.

                   

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

                	
                  Ten
      dollars ($10.00) per visit waived if admitted or authorized by primary
      care physician

                
	
                  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.

                	
                  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.

                	
                  NONE

                
	
                  D.  Organ
      Transplantation

                        Services

                  Covered
      services include pretransplant, transplant, post discharge 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 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, 

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

                   

                  Routine
      hearing screening must be provided by primary care physician.

                   

                  Family
      planning limited to one annual visit and one supply visit each ninety (90)
      days.

                   

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

                   

                  Podiatric
      services are limited to one (1) visit per day totaling two (2) 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 defined as a drug,
      biological 

                   

                   

                   

                	
                  None
      Co-Payment for well child care, preventive care or for routine vision and
      hearing screenings.

                  Five
      dollars ($5.00) per office visit

                

        

         

        
          	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

        

        
          
            
            

          

          
            Page 56
of 63

            
              

            

          

          
            
            

          

        

         

        
          
            
              	
                      BENEFIT

                    	
                      LIMITATIONS

                    	
                      CO-PAYMENTS

                    

            

          

        

        
          	
                   
      laboratory and other outpatient diagnostic tests; 

                   ambulatory
      surgical procedures; splints and casts; 

                   consultation
      with and treatment by referral 

                   physicians;
      radiation and chemotherapy; 

                   chiropractic
      services; and  podiatric services.

                	
                  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 Enrollee 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 Enrollee 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.

                	 
	
                  F.
      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.

                  Covered
      services include inpatient and outpatient services for mental and nervous
      disorders as defined in the most recent edition of the Diagnostic and
      Statistical Manual of Mental Disorders published by the American
      Psychiatric Association.

                  Such
      benefits include psychological or psychiatric evaluation, diagnosis and
      treatment by a licensed mental health professional meeting the
      requirements of Section 3-21 of this Contract.

                  Any
      benefit limitations, including duration of services, number of visits, or
      number of days for hospitalization or residential services, shall not be
      any less favorable than those for physical illnesses
      generally.

                   

                  INSURER
      may also implement appropriate financial incentives, peer review,
      utilization requirements, and other methods used for the management of
      benefits provided for other medical conditions in order to reduce service
      costs and utilization without compromising quality of care subject to the
      prior review and approval of FHKC.

                   

                   

                	
                  INPATIENT:
      NONE

                  OUTPATIENT:
      Five dollars

                  ($5.00)
      per visit.

                

        

         

        
          	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

        

        
          
            
            

          

          
            Page 57
of 63

            
              

            

          

          
            
            

          

        

         

        
          
            
              	
                      BENEFIT

                    	
                      LIMITATIONS

                    	
                      CO-PAYMENTS

                    

            

          

        

        
          	
                  G.  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.

                  Covered
      services include inpatient, outpatient and residential services for
      substance disorders.

                   

                  Such
      benefits include evaluation, diagnosis and treatment by a licensed
      professional meeting the requirements of Section 3-21 of this
      Contract.

                   

                  Any
      benefit limitations, including duration of services, number of visits, or
      number of days for hospitalization or residential services, shall not be
      any less favorable than those for physical illnesses
      generally.

                   

                  INSURER
      may also implement appropriate financial incentives, peer review,
      utilization requirements, and other methods used for the management of
      benefits provided for other medical conditions in order to reduce service
      costs and utilization without compromising quality of care subject to the
      prior review and approval of FHKC.

                   

                	
                  INPATIENT:
      NONE

                  OUTPATIENT:

                  Five
      dollars ($5.00) per visit.

                
	
                  H.  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 (24) treatment sessions within a sixty (60) day
      period per episode or injury, with the sixty (60) day period beginning
      with the first (1st)
      treatment.

                	
                  Five
      dollars ($5.00) per visit.

                
	
                  I.  Home Health Services

                  Includes
      prescribed home visits by both registered and licensed practical nurses to
      provide skilled nursing services on a part-time intermittent
      basis.

                	
                  Coverage
      is limited to skilled nursing services only.

                  Meals,
      housekeeping and personal comfort items are excluded.

                  Services
      must be provided directly by INSURER.

                  Private
      duty nursing is limited to circumstances where such care is medically
      appropriate.

                   

                	
                  Five
      dollars ($5.00) per visit.

                
	
                  J.  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
      that treat the terminal condition will not be covered.

                   

                  Services
      required for conditions totally unrelated to the terminal condition are
      covered to the extent that such services are otherwise covered under this
      contract.

                	
                  Five
      dollars ($5.00) per visit.

                
	
                  K.
      Nursing Facility
Services

                  Covered
      services include regular nursing services, rehabilitation services, drugs
      and 

                	
                  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
      an INSURER physician.

                   

                  
                  

                	
                  NONE

                

        

         

        
          	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

        

        
          
            
            

          

          
            Page 58
of 63

            
              

            

          

          
            
            

          

        

         

        
          
            
              
                	
                        BENEFIT

                      	
                        LIMITATIONS

                      	
                        CO-PAYMENTS

                      

              

            

          

          
            	
                     
       biologicals, medical supplies, and the use of  

                     
      appliances and equipment furnished by the facility.

                  	
                    
                      The
      length of the Enrollee’s stay shall be determined by the medical condition
      of the Enrollee in relation to the necessary and appropriate level of
      care, but maybe no more than one hundred (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 treatment centers are
      excluded.

                      Private
      duty nurses, television, and custodial care are excluded.

                      Admissions
      for rehabilitation and physical therapy are limited to fifteen (15) days
      per contract year.

                    

                  	 

          

        

         

        
          	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

        

        
          
            
            

          

          
            Page 59
of 63

            
              

            

          

          
            
            

          

        

         

        
          
            
              	
                      BENEFIT

                    	
                      LIMITATIONS

                    	
                      CO-PAYMENTS

                    

            

          

        

        
          	
                  L.
      Durable
      Medical Equipment and
      Prosthetic

                        Devices

                  Equipment and devices that are medically indicated
      to assist in the treatment of a medical condition and specifically
      prescribed as medically necessary by Enrollee’s
      INSURER physician.

                	
                  Equipment
      and devices must be provided by authorized INSURER supplier.

                   

                  Covered
      prosthetic devices include artificial eyes, limbs, braces and other
      artificial aids.

                   

                  Low
      vision and telescopic lenses are not included.

                   

                  Hearing
      aids are covered only when medically indicated to assist in the treatment
      of a medical condition.

                	
                  NONE

                   

                
	
                  M.  Refractions

                  Examination
      by a INSURER optometrist to determine the need for and to prescribe
      corrective lenses as medically indicated.

                	
                  Enrollee
      must have failed vision screening by primary care physician.

                   

                  Corrective
      lenses and frames are limited to one (1) pair every two (2) years unless
      head size or prescription changes.

                   

                  Coverage
      is limited to Medicaid frames with plastic or SYL non-tinted
      lenses.

                	
                  Five
      dollars ($5.00) per visit.

                   

                  Ten
      dollars ($10.00) for corrective lenses.

                
	
                  M.
      Pharmacy

                  Prescribed
      drugs for the treatment of illness or injury or injury.

                	
                  Prescribed
      drugs covered under this Agreement shall include all prescribed drugs
      covered under the Florida Medicaid program.  INSURER is
      responsible for the coverage any drugs prescribed by Enrollee’s dental
      provider under Healthy Kids.

                   

                  INSURER
      may implement cost utilization controls or a pharmacy benefit management
      program if FHKC 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 Enrollee’s primary care physician,
      INSURER approved specialist or consultant physician or Enrollee’s dental
      provider.

                   

                	
                  Five
      dollars ($5.00) per prescription for up to a thirty one (31) day
      supply.

                   

                   

                
	
                  N.  Transportation Services

                  Emergency
      transportation as determined to be medically necessary in response to an
      emergency situation.

                	
                  Must
      be in response to an emergency situation.

                   

                	
                  Ten
      dollars ($10.00) per service

                

        

      

       

      
        	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

      

      
         

         

      

      
        Page 60
of 63

        
          

        

      

      
         

      

      III.           Cost
Sharing Provisions

      

      INSURER
shall comply with all cost sharing restrictions imposed on Enrollees by federal
or state laws and regulations, including the following specific
provisions:

      

      A.           Special
Populations

      

      FHKC
shall provide to INSURER on a monthly basis those Enrollees identified as Native
Americans or Alaskan Natives who are prohibited from paying any cost sharing
amounts, including co-payments.

       

      
        	
                 
      

              	
                B.

              	
                Cost
      Sharing Limited to No More than Five Percent (5%) of
    Family’s

              

      

       

       
Income

      

      FHKC will
also 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.

      

      INSURER
is responsible for informing its Providers of these provisions and ensuring that
such Enrollees 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.

      

      IV.           Prior
Authorization Requirements

      

      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
or state regulations.

       

      
        	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

      

      
         

         

      

      
        Page 61
of 63

        
          

        

      

      
         

      

      

      
         ATTACHMENT
E – LIST OF REQUIRED REPORTS

      

      

      The
following chart summarizes the reports required under this Contract according to
the frequency of submission.  Monthly reports are due on the fifteenth
(15th) of
each month for the prior month; quarterly reports are due by the fifteenth
(15th) of
each month following the end of each quarter and annual reports are due by July
1st
(first) unless otherwise noted.

      

      This
chart is provided for reference purposes only; the provisions of the Contract
and any reporting requirements included herein will control.

      

      
        	
                At
      Contract Execution

              	
                Immediately

              	
                Monthly

              	
                Quarterly

              	
                Annually

              
	
                Insurance
      Coverages (Section 3-15)

              	
                Section
      3-19 Requirements (Section 3-19)

              	
                Provider
      Network Changes (Section 3-19)

              	
                Statistical
      Claims Data Reporting (Section 3-26)

              	
                Grievance
      Process

                (Section
      3-13)

              
	
                Lobbying
      Disclosures

                 (Section
      3-16)

              	
                Grievances
      before the Subscriber Assistance Panel

                (Section
      3-13)

              	 
      	
                Reports
      of filed Grievances (Section 3-13)

              	
                Lobbying
      Certification

                (Section
      3-16)

              
	
                Quality
      Assurance Plan (Section 3-22)

              	
                Termination
      of subcontractors or affiliates

                (Section
      3-29)

              	 
      	
                Medical
      Loss Ratio Reports

                (Section
      3-20-2)

              	
                Experience
      Adjustment – April 1

                 (Section
      3-20-3)

              
	
                Conflicts
      of Interest Disclosure Form

                (Section
      4-8)

              	
                Change
      of ownership or controlling interest

                (Section
      4-6)

              	 
      	
                Network
      Adequacy Attestations

                (Section
      3-29)

                 

              	
                Audited
      financial statements (Section 3-23)

                 

              
	
                Fraud
      and Abuse Preventions (Section)

                 

              	
                Change
      of Notice and Contract contact (Section 4-15)

              	 
      	 
      	
                Listing
      of Subcontractors and affiliates (Section 3-29)

              
	
                Quality
      Improvement Plan

                (Section)

              	
                Conflicts
      of Interest Disclosure Form (Section 4-8)

              	 
      	 
      	
                Member
      materials

                (Section
      3-18)

              
	
                Cultural
      Competency Plan

                (Section)

              	 
      	 
      	 
      	
                Proof
      of insurance coverage (3-15)

              
	 
      	 
      	 
      	 
      	
                Fraud
      and Abuse Preventions

              
	 
      	 
      	 
      	 
      	
                Quality
      Improvement Plan

              
	 
      	 
      	 
      	 
      	
                Cultural
      Competency Plan

              

      

      

      
        	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

      

      
         

         

      

      
        Page 62
of 63

        
          

        

      

      
         

      

      ATTACHMENT
F – DISCLOSURE FORM

      

      INSURER
NAME:      _____________________________

      

      The
following are relationships, business and personal, that may create a conflict
of interest that INSURER is hereby disclosing:

      

      
        	
                Type
      of Relationship

                (Business,
      Personal)

              	
                Name
      of Organization or Individual

              	
                Status
      of Organization or Individual

                (Current
      Contractor, Applicant, Enrollee, etc.)

              	
                Term
      of Relationship

              
	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      
	 
      	 
      	 
      	 
      

      

      

      By my
signature, I certify that the information contained in this report and any
attachments to this document are true representations. INSURER understands that
if any information is found to be false that the Contract between FHKC and
INSURER may be terminated at FHKC’s sole discretion.

      

      Submitted
By:                                                                           Date
of Submission:

      

      /s/ Heath
Schiesser                           
                                      29 September
2009      

      (Signature
Above)

      Name:  Heath Schiesser

      Title:  President & CEO

       

      
        	Florida Healthy Kids
      Corporation 	 	       /s/
      RR  FHKC
	Effective Date
      -October 1, 2009	 	   /s/ HS 
  INSURER

      

      
         

         

      

      
        Page 63
of 63ex10-9.htm

    Exhibit
10.9

    

    Form
of Amendment No. 1 to Employment Agreement

    

    AMENDMENT NO.
1

    TO EMPLOYMENT
AGREEMENT

    

    THIS AMENDMENT NO. 1 TO EMPLOYMENT
AGREEMENT(the "Agreement") is made and entered into as of the 29th day of
September, 2009 by and between Digital Lifestyles Group, Inc., a Delaware
corporation whose principal place of business is 649 Sparta Highway, Suite 102,
Crossville, TN  38555 (the "Corporation") and Ken Page, an individual
whose mailing address is ____________________ (the "Employee").

    

    RECITALS

    

    WHEREAS, the Corporation and
the Employee are parties to that certain Employment Agreement dated as of
September 27, 2007, a copy of which is attached hereto as Exhibit A and
incorporated herein by such reference (the “Employment Agreement”).

    

    WHEREAS, the term of the
Employment Agreement has automatically renewed for an additional one year term
pursuant to the provisions of Section 2 thereof.

    

    WHEREAS, the parties are
desirous of amending certain terms of the Employment Agreement.

    

    NOW, THEREFORE, in
consideration of the mutual agreements herein made, the Corporation and the
Employee do hereby agree as follows:

    

    1.           Recitals.  The
above recitals are true, correct, and are herein incorporated by
reference.

    

    2.           Adjustment
in Base Salary.  Section 3(a) of the Employment Agreement is
hereby amended to provide that the Base Salary payable to the Employee shall be
$4,166.67 per month commencing upon the date hereof.

    

    3.           Additional
Compensation.
Subject to continued employment, and as additional compensation to the
Employee, the Corporation shall grant the Employee five year non-qualified
options pursuant to the Corporation’s 2009 Stock Compensation Plan to purchase
an aggregate of 120,000 shares of the Corporation’s common stock at an exercise
price of $0.25 per share, which such options shall vest in equal monthly
installments of 10,000 options on the last date of each month commencing in
September 2009.  Upon vesting, such options shall be immediately
exercisable by the Employee.

    

    4.           No Other
Amendments.  Unless specifically amended hereby, all other
terms and conditions of the Employment Agreement shall remain in full force and
effect.

    

    5.           Completeness
and Modification.  This Agreement and the Employment Agreement
constitutes the entire understanding between the parties hereto superseding all
prior and contemporaneous agreements or understandings among the parties hereto
concerning the Employment Agreement.  This Agreement may be amended,
modified, superseded or canceled, and any of the terms, covenants,
representations, warranties or conditions hereof may be waived, only by a
written instrument executed by the parties or, in the case of a waiver, by the
party to be charged.

    

    
      
        
        

      

      
        
        

        
          

        

      

      
        
        

      

       

    

    6.           Counterparts.  This
Agreement may be executed in two or more counterparts, each of which shall be
deemed an original but all of which shall constitute but one
agreement.

    

    7.           Binding
Effect/Assignment.  This Agreement shall be binding upon the
parties hereto, their heirs, legal representatives, successors and
assigns.  This Agreement shall not be assignable by the Employee but
shall be assignable by the Corporation in connection with the sale, transfer or
other disposition of its business or to any of the Corporation's affiliates
controlled by or under common control with the Corporation.

    

    8.           Governing
Law.  This Agreement shall become valid when executed and
accepted by Corporation.  The parties agree that it shall be deemed
made and entered into in the State of Tennessee and shall be governed and
construed under and in accordance with the laws of the State of
Tennessee.  Anything in this Agreement to the contrary
notwithstanding, the Employee shall conduct the Employee's business in a lawful
manner and faithfully comply with applicable laws or regulations of the state,
city or other political subdivision in which the Employee is
located.

    

    9.           Further
Assurances.  All parties hereto shall execute and deliver such
other instruments and do such other acts as may be necessary to carry out the
intent and purposes of this Agreement.

    

    10.         Headings.  The
headings of the sections are for convenience only and shall not control or
affect the meaning or construction or limit the scope or intent of any of the
provisions of this Agreement.

    

    11.         Severability.  The
invalidity or unenforceability, in whole or in part, of any covenant, promise or
undertaking, or any section, subsection, paragraph, sentence, clause, phrase or
word or of any provision of this Agreement shall not affect the validity or
enforceability of the remaining portions thereof.

    

    12.         Construction.  This
Agreement shall be construed within the fair meaning of each of its terms and
not against the party drafting the document. 

    

    13.        
Advice of
Counsel.  THE EMPLOYEE ACKNOWLEDGES THAT, IN EXECUTING THIS
AGREEMENT, HE HAS HAD THE OPPORTUNITY TO SEEK THE ADVICE OF INDEPENDENT LEGAL
COUNSEL AND TAX PROFESSIONALS, AND HAS READ AND UNDERSTOOD ALL OF THE TERMS AND
PROVISIONS OF THIS AGREEMENT.

    

    IN WITNESS WHEREOF, the
parties have executed this Agreement as of date set forth in the first paragraph
of this Agreement.

     

    
      
        
          
            
              	 	Digital Lifestyles
      Group, Inc.	 
	 	 	 	 
	
                       

                    	
                      By:
      

                    	 	 
	 	 	Brad McNeil,
      Director	 
	 	 	 	 
	 	 	 	 
	 	 	 	 
	 	 	Ken
      Page	 

            

          

        

      

    

     

     

     

    2

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