Document:

attestationh1216.htm

Back to Form 8-K

Medicare Advantage Attestation of Benefit Plan 

 

HARMONY HEALTH PLAN OF ILLINOIS, INC. 

 

H1216

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 2012. 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 2011 and 2012, including but not limited to, the 2012 Call Letter, the 2012 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

	
7

	
WellCare Value (HMO-

POS)

	
HMOPOS

	
Renewal

	
0.00

	
0.00

	
09/02/11

	
01/01/12

	
003

	
0

	
8

	
WellCare Access 

(HMO SNP)

	
HMO

	
Renewal

	
0.00

	
28.10

	
09/02/11

	
01/01/12

 

 

 

 

	 	 	 	 H1216

                                                                         

  

  

  

 

 

 

	
THOMAS TRAN

 

	 	 9/1/2011 10:45:27 AM	 
	
 

Contracting Official Name 

	 	 Date	 

 

 

 

 

	
HARMONY HEALTH PLAN OF ILLINOIS, INC.

 

	 	
23 Public Square

Suite 400

Belleville, IL 62220

 

	 
	
 

Organization 

	 	
 

Address

	 

                    

 

 

 

 

                                                         

	 	 	 	 H1216attestationh1264.htm

Back to Form 8-K

Medicare Advantage Attestation of Benefit Plan

 

WELLCARE OF TEXAS, INC.

 

H1264

 

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 2012. 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 2011 and 2012, including but not limited to, the 2012 Call Letter, the 2012 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

	
004

	
0

	
7

	
WellCare Value (HMO 

-POS)

	
HMOPOS

	
Renewal

	
0.00

	
0.00

	
09/02/11

	
01/01/12

	
007

	
0

	
8

	
WellCare Access 

(HMO SNP)

	
HMO

	
Renewal

	
0.00

	
28.60

	
09/02/11

	
01/01/12

	
008

	
0

	
7

	
WellCare Dividend (HMO)

	
HMO

	
Renewal

	
0.00

	
0.00

	
09/02/11

	
01/01/12

	
014

	
0

	
7

	
WellCare Dividend (HMO)

	
HMO

	
Renewal

	
0.00

	
0.00

	
09/02/11

	
01/01/12

 

 

 

 

 

                                                         

	 	 	 	 H1264

                                                                         

  

  

  

 

 

	
THOMAS TRAN

 

	 	 9/1/2011 10:46:31 AM	 
	
 

Contracting Official Name 

	 	 Date	 

 

 

 

 

	
WELLCARE OF TEXAS, INC.

 

	 	
8735 Henderson Rd

Ren 1 

Tampa, FL 33634

 

	 
	
 

Organization 

	 	
 

Address

	 

                    

 

 

 

 

                                                         

	 	 	 	 H1264attestationh1416.htm

Back to Form 8-K

 

Medicare Advantage Attestation of Benefit Plan 

 

HARMONY HEALTH PLAN OF ILLINOIS, INC. 

 

H1416

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 2012. 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 2011 and 2012, including but not limited to, the 2012 Call Letter, the 2012 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

	
007

	
0

	
8

	
WellCare Access 

(HMO SNP)

	
HMO

	
Renewal

	
0.00

	
13.70

	
09/02/11

	
01/01/12

	
009

	
0

	
8

	
WellCare Value (HMO 

-POS)

	
HMOPOS

	
Renewal

	
0.00

	
0.00

	
09/02/11

	
01/01/12

	
019

	
0

	
9

	
WellCare Rx (HMO)

	
HMO

	
Renewal

	
0.00

	
32.80

	
09/02/11

	
01/01/12

 

 

 

 

 

 

 

	 	 	 	 H1416

                                                                         

  

  

  

	
THOMAS TRAN

 

	 	 9/1/2011 10:47:46 AM	 
	
 

Contracting Official Name 

	 	 Date	 

 

 

 

 

	

HARMONY HEALTH PLAN OF ILLINOIS, INC. 

	 	
125 SOUTH WACKER DRIVE SUITE 2600

CHICAGO, IL 606064402

 

	 
	
 

Organization 

	 	
 

Address

	 

                    

 

 

 

 

                                                         

	 	 	 	 H1416attestationh1903.htm

Back to Form 8-K

Medicare Advantage Attestation of Benefit Plan

 

WELLCARE OF LOUISIANA, INC.

 

H1903

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 2012. 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 2011 and 2012, including but not limited to, the 2012 Call Letter, the 2012 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

	
011

	
0

	
7

	
WellCare Access (HMO SNP)

	
HMO 

	
Renewal

	
0.00

	
35.00

	
09/02/11

	
01/01/12

	
022

	
0

	
7

	
WellCare Value (HMO- 

POS)

	HMOPOS	
Renewal

	
0.00

	
0.00

	
09/02/11

	
01/01/12

	
024

	
0

	
8

	
 WellCare Dividend 

(HMO-POS)

	
HMOPOS

	
Renewal

	
0.00

	
0.00

	
09/02/11

	
01/01/12

 

 

 

 

 

	 	 	 	 H1903

                                                                         

 

  

  

  

	
THOMAS TRAN

 

	 	 9/1/2011 10:48:50 AM	 
	
 

Contracting Official Name 

	 	 Date	 

 

 

 

 

	
WELLCARE OF LOUISIANA, INC.

 

	 	
8735 Henderson Rd

Ren 1 

Tampa, FL 33634

 

	 
	
 

Organization 

	 	
 

Address

	 

                    

 

 

 

 

                                                         

	 	 	 	 H1903attestationh2491.htm

Back to Form 8-K

Medicare Advantage Attestation of Benefit Plan

 

WELLCARE HEALTH INSURANCE OF ARIZONA, INC. 

 

H2491

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 2012. 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 2011 and 2012, including but not limited to, the 2012 Call Letter, the 2012 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

	
7

	
'Ohana Reserve (HMO- POS)

	
HMOPOS

	
Renewal

	
0.00

	
30.40

	
09/02/11

	
01/01/12

	
002

	
0

	
7

	
'Ohana Value (HMO- POS)

	
HMOPOS

	
Renewal

	
0.00

	
0.00

	
09/02/11

	
01/01/12

	
004

	
0

	
8

	
'Ohana Liberty (HMO- POS SNP)

	
HMOPOS

	
Renewal

	
0.00

	
30.40

	
09/02/11

	
01/01/12

 

 

 

 

 

 

	 	 	 	 H2491

                                                                         

 

  

  

  

 

	
THOMAS TRAN

 

	 	 9/1/2011 10:50:02 AM	 
	
 

Contracting Official Name 

	 	 Date	 

 

 

 

 

	

WELLCARE HEALTH INSURANCE OF ARIZONA, INC. 

	 	
8735 Henderson Rd

Ren 1 

Tampa, FL 33634

 

	 
	
 

Organization 

	 	
 

Address

	 

                    

 

 

 

 

                                                         

	 	 	 	 H2491

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