Document:

h3361benefitattestation.htm

Back to Form 8-K

Exhibit 10.13

 

Medicare Advantage Attestation of Benefit Plan

 

WELLCARE_OF NEW YORK, INC.

 

H3361 

 

Date: 08/29/2012

 

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

 

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

 

	
Plan

ID

	
Segment

ID

	
Version

	
Plan Name

	
Plan

Type

	
Transaction

Type

	
MA

Premium

	
Part D 

Premium

	
CMS Approval 

Date

	
Effective

Date

	
043

	
0

	
6

	
WellCare Liberty (HMO SNP)

	
HMO

	
Renewal

	
0.00

	
20.60

	
08/20/2012

	
01/01/2013

	
059

	
0

	
5

	
WellCare Advance (HMO)

	
HMO

	
Renewal

	
0.00

	
N/A

	
08/20/2012

	
01/01/2013

	
065

	
0

	
7

	
WellCare Access (HMO SNP)

	
HMO

	
Renewal

	
0.00

	
18.90

	
08/20/2012

	
01/01/2013

	
098

	
0

	
6

	
WellCare Liberty (HMO SNP)

	
HMO

	
Renewal

	
0.00

	
16.90

	
08/20/2012

	
01/01/2013

	
099

	
0

	
8

	
WellCare Value (HMO- POS)

	
HMOPOS

	
Renewal

	
0.00

	
0.00

	
08/24/2012

	
01/01/2013

	
105

	
0

	
6

	
WellCare Advocate Complete (HMO SNP)

	
HMO

	
Renewal

	
0.00

	
28.40

	
08/20/2012

	
01/01/2013

	
106

	
0

	
6

	
WellCare Choice (HMO- POS)

	
HMOPOS

	
Renewal

	
0.00

	
0.00

	
08/20/2012

	
01/01/2013

	
109

	
0

	
6

	
WellCare Access (HMO SNP)

	
HMO

	
Renewal

	
0.00

	
40.40

	
08/20/2012

	
01/01/2013

	
129

	
0

	
6

	
WellCare Choice (HMO- POS)

	
HMOPOS

	
Renewal

	
0.00

	
0.00

	
08/20/2012

	
01/01/2013

	
130

	
0

	
6

	
WellCare Rx (HMO)

	
HMO

	
Renewal

	
0.00

	
1.60

	
08/20/2012

	
01/01/2013

 

 

 

	
H3361

  

  

  

 

	 THOMAS TRAN	 	 8/29/2012 2:07:21 PM	 
	  	 	 	 
	 Contracting Official Name	 	 Date	 
	 	 	 	 
	 	 	 	 
	 	 	 	 
	 	 	 P.O. BOX 1652	 
	 WELLCARE_OF NEW YORK, INC.	 	 NEWBURGH, NY 12551	 
	 	 	 	 
	 Organization	 	 Address	 

 

 

 

 

 

 

H3361h9730benefitattestation.htm

Back to Form 8-K

Exhibit 10.14

Medicare Advantage Attestation of Benefit Plan 

 

WELLCARE HEALTH INSURANCE OF ILLINOIS, INC.

 

H9730 

 

Date: 08/29/2012

 

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

 

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

 

	
Plan

ID

	
Segment

ID

	
Version

	
Plan Name

	
Plan

Type

	
Transaction

Type

	
MA

Premium

	
Part D 

Premium

	
CMS Approval 

Date

	
Effective

Date

	
001

	
0

	
6

	
WellCare Access (HMO SNP)

	
HMO

	
Initial

	
0.00

	
16.00

	
08/20/2012

	
01/01/2013

	
002

	
0

	
7

	
WellCare Value (HMO -POS)

	
HMOPOS

	
Initial

	
0.00

	
0.00

	
08/20/2012

	
01/01/2013

 

 

 

	

H9730 

  

  

  

 

	 THOMAS TRAN	 	 8/29/2012 2:08:56	 
	  	 	 	 
	 Contracting Official Name	 	 Date	 
	 	 	 	 
	 	 	 	 
	 	 	 	 
	 	 	 8735 Henderson Road	 
	 WELLCARE HEALTH INSURANCE OF ILLINOIS, INC.	 	 Tampa, FL 33634	 
	 	 	 	 
	 Organization	 	 Address	 

 

 

 

 

 

H9730formmedicarecaremarklicense.htm

Back to Form 8-K

 

Exhibit 10.15

MEDICARE MARK LICENSE AGREEMENT

 

THIS AGREEMENT is made and entered into 8/29/2012

 

by and between

 

	
THE CENTERS FOR MEDICARE & MEDICAID SERVICES (hereinafter "Licensor"),

with offices located at 7500 Security Blvd., Baltimore, MD 21244

and

 [____________________] (hereinafter "Licensee"),

with offices located at P.O. Box 26011

Tampa, FL 336236011

 

CMS Contract ID:  [_______]

 

 

 

	Page 1 of 3	 	 	 [_____]

  

  

  

 

WITNESSETH

 

WHEREAS, Licensor is the owner of the Medicare Prescription Drug Benefit program, a program authorized under Title XVIII, Part D of the Social Security Act (Part D), Mark (the "Mark").

WHEREAS, Licensee desires to use the Mark on Part D marketing materials (including the identification card) beginning October 15, 2012.

WHEREAS, both parties, in consideration of the premises and promises contained herein and other good and valuable consideration which the parties agree is sufficient, and each intending to be legally bound thereby, the parties agree as follows:

 

	
  

	
1.

	
Subject to the terms and conditions of this Agreement, Licensor hereby grants to Licensee a non-exclusive right to use the Mark in their Part D marketing materials.

	
  

	
2.

	
Licensee acknowledges Licensor's exclusive right, title, and interest in and to the Mark and will not, at any time, do or cause to be done any act or thing contesting or in any way impairing or tending to impair any part of such right, title, and interest. Licensee acknowledges that the sole right granted under this Agreement with respect to the Mark is for the purposes described herein, and for no other purpose whatsoever.

	
  

	
3.

	
Licensor retains the right to use the Mark in the manner or style it has done so prior to this Agreement and in any other lawful manner.

	
  

	
4.

	
This Agreement and any rights hereunder are not assignable by Licensee and any attempt at assignment by Licensee shall be null and void.

	
  

	
5.

	
Licensor, or its authorized representative, has the right, at all reasonable times, to inspect any material on which the Mark is to be used, in order that Licensor may satisfy itself that the material on which the Mark appears meets with the standards, specifications, and instructions submitted or approved by Licensor.  Licensee shall use the Mark without modification and in accordance with the Mark usage policies described within the Medicare Marketing Guidelines. Licensee shall not take any action inconsistent with the Licensor's ownership of the Mark, and any goodwill accruing from use of such Mark shall automatically vest in Licensor.

	
  

	
6.

	
This agreement shall be effective on the date of signature by the Licensee's authorized representative through December 31, 2013, concurrent with the execution of the Part D contract (or Part D addendum to a Medicare Managed Care contract). This Agreement may be terminated by either party upon written notice at any time. Licensee agrees, upon written notice from Licensor, to discontinue any use of the Mark immediately. Starting December 31, 2013, this agreement shall be renewable for successive one-year periods running concurrently with the term of the Licensee's Part D contract. This agreement shall terminate, without written notice, upon the effective date of termination or non-renewal of the Licensee's Part D contract (or Part D addendum to a Medicare Managed Care contract).

	
  

	
7.

	
Licensee shall indemnify, defend and hold harmless Licensor from and against all liability, demands, claims, suits, losses, damages, infringement of proprietary rights, causes of action, fines, or judgments (including costs, attorneys' and witnesses' fees, and expenses incident thereto), arising out of Licensee's use of the Mark.

	
  

	
8.

	
Licensor will not be liable to Licensee for indirect, special, punitive, or consequential damages (or any loss of revenue, profits, or data) arising in connection with this Agreement even if Licensor has been advised of the possibility of such damages.

	
  

	
9.

	
This Agreement is the entire agreement between the parties with respect to the subject matter hereto.

	
  

	
10.

	
Federal law shall govern this Agreement.

 

	Page 2 of 3	 	 	 [_____]

 

  

  

  

IN WITNESS WHEREOF, the parties hereto have executed this Agreement by their duly authorized officers as of the date first set forth above.

 

This document has been electronically signed by:

FOR THE LICENSEE:

/s/ THOMAS TRAN

	 	 	 	 

 

Contracting Official Name

8/29/2012

	 	 	 	 

 

Date

[                            ]

	 	 	 	 

Organization

FOR THE LICENSOR

                                                                     

	 /s/ Cynthia Tudor   	 	
 

9/14/2012

	 
	  

Cynthia Tudor, PhD

Director

Medicare Drug Benefit

and C & D Data Group,

Center for Medicare

	 	
 

Date

 

 

 

 

	 

 

 

	Page 3 of 3	 	 	 [_____]

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