Document:

attestationh0712.htm

Back to Form 8-K

Exhibit 10.4

 

Medicare Advantage Attestation of Benefit Plan

 

WELLCARE OF CONNECTICUT, INC.

 

H0712

 

I attest that I have examined the Plan Benefit Packages (PBPs) identified below and that the benefits identified in the PBPs are those that the above-stated organization will make available to eligible beneficiaries in the approved service area during program year 2011. 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 2010 and 2011, including but not limited to, the 2011 Call Letter, the 2011 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	 5	 WellCare Choice (HMO-POS)	 HMOPOS	
Renewal

	
22.40

	9.10	
09/03/2010

	
01/01/2011

	

005

	

0

	

5

	

WellCare Access (HMO SNP)

	

HMO

	

Renewal

	

0.00

	

33.70

	

09/03/2010

	

01/01/2011

	

018

	

0

	

8

	

WellCare Premium (HMO-POS)

	

HMOPOS

	

Renewal

	

69.40

	

32.60

	

09/03/2010

	

01/01/2011

 

H0712

  

  

  

	
Thomas Tran

	  	
9/2/2010 7:54:07AM

	  	  	 	  
	  	  	  
	
Contracting Official Name

	
Date

	  	  	  
	  	  	  
	  	  	  
	
WELLCARE OF CONNECTICUT INC.

	
116 WASHINGTON AVENUE

	  	  	
NORTH HAVEN, CT 06437

	  	  	 	  
	  	  	 	  
	
Organization

	
Address

	  	  	  

H0712attestationh0913.htm

Back to Form 8-K

Exhibit 10.5

 

Medicare Advantage Attestation of Benefit Plan

 

WELLCARE HEALTH PLANS OF NEW JERSEY, INC.

 

H0913

 

I attest that I have examined the Plan Benefit Packages (PBPs) identified below and that the benefits identified in the PBPs are those that the above-stated organization will make available to eligible beneficiaries in the approved service area during program year 2011. 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 2010 and 2011, including but not limited to, the 2011 Call Letter, the 2011 Solicitations for New Contract Applicants, the Medicare Prescription Drug Benefit Manual, the Medicare Managed Care Manual, and the CMS memoranda issued through the Health Plan Management System (HPMS).

 

	

Plan 

ID

	

Segment 

ID

 

	

Version

	

Plan Name

	

Plan 

Type

	

Transaction

Type

	

MA 

Premium

	

Part D 

Premium

	

CMS Approval

Date

	

Effective 

Date

	

002

	

0

	

5

	

WellCare Value (HMO)

	

HMO

	

Renewal

	

0.00

	

0.00

	

09/03/2010

	

01/01/2011

	

003

	

0

	

6

	

WellCare Access (HMO

SNP)

	

HMO

	

Renewal

	

0.00

	

35.70

	

09/03/2010

	

01/01/2011

 

H0913

 

  

  

  

	
Thomas Tran

	  	
9/2/2010 7:55:00AM

	  	  	 	  
	  	  	  
	
Contracting Official Name

	
Date

	  	  	  
	  	  	  
	  	  	  
	
WELLCARE HEALTH PLANS OF NEW JERSEY, INC.

	
P.O.Box 26011

	  	  	
Tampa, FL 336236011

	  	  	 	  
	  	  	 	  
	
Organization

	
Address

	  	  	  

H0913attesttationh1032.htm

Back to Form 8-K

Exhibit 10.6

 

Medicare Advantage Attestation of Benefit Plan 

 

WELL CARE OF FLORIDA, INC.

 

H1032

 

I attest that I have examined the Plan Benefit Packages (PBPs) identified below and that the benefits identified in the PBPs are those that the above-stated organization will make available to eligible beneficiaries in the approved service area during program year 2011.  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 2010 and 2011, including but not limited to, the 2011 Call Letter, the 2011 Solicitations for New Contract Applicants, the Medicare Prescription Drug Benefit Manual, the Medicare Managed Care Manual, and the CMS memoranda issued through the Health Plan Management System (HPMS).

 

	

Plan

ID

	

Segment

ID

	

Version

	

Plan Name

	

Plan

Type

	

Transaction

Type

	

MA

Premium

	

Part D

Premium

	

CMS Approval Date

	

Effective

Date

	

002

	

0

	

5

	

WellCare Choice (HMO-POS)

	

HMOPOS

	

Renewal

	

35.60

	

12.40

	

09/03/2010

	

01/01/2011

	

008

	

0

	

5

	

WellCare Choice (HMO) 

	

HMO

	

Renewal

	

0.00

	

0.00

	

09/03/2010

	

01/01/2011

	

012

	

0

	

5

	

WellCare Choice (HMO-POS)

	

HMOPOS

	

Renewal

	

0.00

	

0.00

	

09/03/2010

	

01/01/2011 

	

014

	

0

	

5

	

WellCare Choice (HMO-POS)

	

HMOPOS

	

Renewal

	

0.00

	

0.00

	

09/03/2010

	

01/01/2011

	

025

	

0

	

5

	

WellCare Choice (HMO-POS)

	

HMOPOS

	

Renewal

	

27.70

	

11.30

	

09/03/2010

	

01/01/2011

	

032

	

0

	

7

	

WellCare Dividend (HMO)

	

HMO

	

Renewal

	

0.00

	

0.00

	

09/03/2010

	

01/01/2011 

	

035

	

0

	

4

	

WellCare Value (HMO- POS)

	

HMOPOS

	

Renewal

	

0.00

	

0.00

	

09/03/2010

	

01/01/2011

	

037

	

0

	

4

	

WellCare Advance (HMO)

	

HMO

	

Renewal

	

0.00

	

N/A

	

09/03/2010

	

01/01/2011 

	

040

	

0

	

4

	

WellCare Dividend (HMO)

	

HMO

	

Renewal

	

0.00

	

0.00

	

09/03/2010

	

01/01/2011

	

061

	

0

	

6

	

WellCare Select (HMO-POS SNP)

	

HMOPOS 

	

Renewal

	

0.00

	

23.30

	

09/03/2010

	

01/01/2011

	

073

	

0

	

7

	

WellCare Choice (HMO-POS)

	

HMOPOS

	

Renewal

	

0.00

	

0.00

	

09/03/2010

	

01/01/2011

	

079

	

0

	

5

	

WellCare Value (HMO)

	

HMO

	

Renewal

	

0.00

	

0.00

	

09/03/2010

	

01/01/2011

	

091

	

0

	

6

	

WellCare Value (HMO-POS)

	

HMOPOS

	

Renewal

	

0.00

	

0.00

	

09/03/2010

	

01/01/2011

 

H1032

  

  

  

	

Plan

ID

	

Segment

ID

	

Version

	

Plan Name

	

Plan

Type

	

Transaction

Type

	

MA

Premium

	

Part D

Premium

	

CMS Approval Date

	

Effective

Date

	

101

	

0

	

7

	

WellCare Select (HMO-POS SNP)

	

HMOPOS

	

Renewal

	

0.00

	

25.40

	

09/03/2010

	

01/01/2011

	

124

	

0

	

6

	

WellCare Access (HMO- SNP)

	

HMO

	

Renewal

	

0.00

	

20.30

	

09/03/2010

	

01/01/2011

	

131

	

0

	

6

	

WellCare Dividend (HMO)

	

HMO

	

Renewal

	

0.00

	

0.00

	

09/03/2010

	

01/01/2011

	

132

	

0

	

6

	

WellCare Value (HMO-POS)

	

HMOPOS

	

Renewal

	

0.00

	

0.00

	

09/03/2010

	

01/01/2011

	

133

	

0

	

6

	

WellCare Value (HMO-POS)

	

HMOPOS

	

Renewal

	

0.00

	

0.00

	

09/03/2010

	

01/01/2011

 

H1032

  

  

  

 

 

	Thomas Tran	 	9/2/2010 7:55:33AM	 
	 	 	 	 
	
 

Contracting Official Name

	 	
 

Date

	 

 

 

 

	
 

WELL CARE OF FLORIDA, INC.

	 	
8735 Henderson Road

Tampa, FL 33634

	 
	 	 	 	 
	
 

Organization

	 	
 

Address

	 

 

H1032attestationh1112.htm

Back to Form 8-K

Exhibit 10.7

 

Medicare Advantage Attestation of Benefit Plan

 

WELLCARE OF GEORGIA, INC.

 

H1112

 

I attest that I have examined the Plan Benefit Packages (PBPs) identified below and that the benefits identified in the PBPs are those that the above-stated organization will make available to eligible beneficiaries in the approved service area during program year 2011. 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 2010 and 2011, including but not limited to, the 2011 Call Letter, the 2011 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

	
003

	
0

	
5

	
WellCare Advance (HMO)

	
HMO

	
Renewal

	
0.00

	
N/A

	
09/03/2010

	
01/01/2011

	
006

	
0

	
6

	
WellCare Access (HMO SNP)

	
HMO

	
Renewal

	
0.00

	
22.40

	
09/03/2010

	
01/01/2011

	
027

	
0

	
6

	
WellCare Value (HMO -POS)

	
HMOPOS

	
Renewal

	
0.00

	
0.00

	
09/03/2010

	
01/01/2011

H1112

 

  

  

  

	
Thomas Tran

	  	
9/2/2010 7:55:58 AM

	  	  	 	  
	  	  	  
	
Contracting Official Name

	
Date

	  	  	  
	  	  	  
	  	  	  
	
WELLCARE OF GEORGIA, INC.

	
8735 Henderson Rd

	  	  	
Ren 1

	  	  	Tampa, FL 33634	  
	  	  	 	  
	
Organization

	
Address

	  	  	  

H1112

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