Document:

Exhibit 10.2

    
      

    

    Back to Form 8-K

    Exhibit
      10.2

     

     

     

    

      MEDICAID
        MANAGED CARE MODEL CONTRACT

       

      Contract
        Amendment 

      Between

       City
        of New York

       And

       WellCare
        of New York, Inc.

       

      This
        Amendment, effective April 1, 2006, amends the Medicaid Managed Care Model
        Contract (hereinafter referred to as the "Agreement") made by and between
        the
        City of New York acting through the New York City Department of Health and
        Mental Hygiene (hereinafter referred to as "DOHMH" or "LDSS") and WellCare
        of
        New York, Inc. (hereinafter referred to as "Contractor" or "MCO").

       

      WHEREAS,
        the
        parties entered into an Agreement effective October 1, 2005, for the purpose
        of
        providing prepaid case managed health services to Medical Assistance recipients
        residing in New York City; and

       

      WHEREAS,
        the
        parties desire to amend said Agreement to modify certain provisions to reflect
        current circumstances and intentions;

       

      NOW
        THEREFORE,
        effective April 1, 2006, or such other date as indicated below, it is mutually
        agreed by the parties to amend this Agreement as follows:

       

      1.
        Amend
        Section 1, "Definitions," the definition for "Designated Third Party
        Contractor," to read as follows:

       

      "Designated
        Third Party Contractor"
        means a
        MCO with which the SDOH has contracted to provide Family Planning and
        Reproductive Health Services for FHPlus Enrollees of a MCO that does not
        include
        such services in its Benefit Package or, for the purpose of this Agreement,
        the
        New York State Medicaid fee-for-service program and its participating providers
        and subcontractors.

       

      2.
        The
        attached Appendix C, "New York State Department of Health Requirements for
        the

      Provision
        of Family Planning and Reproductive Health," is substituted for the period
        beginning April 1.2006.

       

      3.
        Effective
        January 1, 2006, Item Number 10 in Section K.I, "Prepaid Benefit Package,"
        of
        Appendix K, "Prepaid Benefit Package Definitions of Covered and Non-Covered
        Services," is amended to read as follows:

       

      
        	
                *

              	
                Covered
                  Services

              	
                MMC
                  Non-SSI

              	
                MMC
                  SSI

              	
                MFFS

              	
                FHPlus
                  **

              
	
                10.

              	
                Prescription
                  and Non-Prescription
                  (OTC) Drugs, 

                Medical
                  Supplies, and Enteral Formula

              	
                Pharmaceuticals
                  and medical
                  supplies

                
                  routinely
                    furnished or administered
                    as part 
                    of
                      a clinic or office visit,
                      except Risperdal
                      Consta [see Appendix
                      K.3,2. b) 
                      xi)
                        of this Agreement]

                    

                  

                

              	
                Pharmaceuticals
                  and medical
                  supplies

                
                  routinely
                    furnished or administered
                    as part of a
                    clinic or office visit, except
                    Risperdal 
                    Consta
                      [see Appendix K.3,
                      2. b) xi) of this 
                      Agreement]

                    

                  

                

              	
                Covered
                  outpatient
                  drugs 
                  from
                    the list of Medicaid
                    reimbursable
                    prescription
                    
                    
                      
                        
                          drugs,
                            subject to any
                            applicable 
                            
                              co-payments

                            

                          

                        

                      

                    

                  

                

              	
                Covered,
                  may be
                  limited to

                
                  
                    generic.
                      Vitamins
                      (except
                      to treat an
                      illness or condition),
                      
                      
                        
                          
                            
                              OTCs,
                                and medical
                                supplies 
                                
                                  are
                                    not
                                    covered

                                

                              

                            

                          

                        

                      

                    

                  

                

              

      

       

      April
        1,
        2006 Amendment
        

      1

       

      

      4.
        Effective January 1, 2006, Subsection xi) is added to Subsection 2.,
        "Non-Covered Behavioral Health Services," b) "Mental Health Services." of
        Section K.3, "Medicaid Managed Care Prepaid Benefit Package Definitions of
        Non-Covered Services," in Appendix K, "Prepaid Benefit Package Definitions
        of
        Covered and Non-Covered Services," and reads as follows:

       

      xi)
        Risperdal Consta, an injectable mental health drug used for management of
        patients with schizophrenia, furnished as part of a clinic or office
        visit.

       

      All
        other
        provisions of said AGREEMENT shall remain in full force and effect.

       

      This
        Agreement is effective April 1, 2006 and shall remain in effect until September
        30, 2007 or until the execution of an extension, renewal or successor agreement
        as provided for in the Agreement.

       

      In
        Witness Whereof, the parties have duly executed this Amendment to the Agreement
        on the dates appearing below their respective signatures.

       

      
        	
                 

                By:
                  /s/ Todd S. Farha .

                WellCare
                  of New York, Inc. 

              	
                 

                By: 
                  /s/  Andrew Rein

                New
                  York City DOHMH

              
	
                 

                Todd
                  S. Farha   

                Printed
                  Name

              	
                 

                 Andrew
                  Rein    

                Printed
                  Name

              
	
                 

                Date:
                  5/25/06

              	
                 

                Date: 
                  7/13/06

              

      

       

       

      April1,
        2006
Amendment
        

      2

       

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

       

      STATE
        OF
        FLORIDA

      
        SS:

      

      COUNTY
        OF
        HILLSBOROUGH

       

      

       

      On
        this
25 day of May, 2006, Todd S. Farha came before me, to me
        known and known to be the President and CEO of WellCare of New York,
        Inc., who is duly authorized to execute the foregoing instrument on behalf
        of said corporation and s/he acknowledged to me that s/he executed the same
        for
        the purpose therein mentioned.

       

       

      /s/ 
        Rebecca Neal 

      NOTARY
        PUBLIC

       

       

       

      STATE
        OF
        NEW YORK)

      SS:

      COUNTY
        OF
        NEW YORK

       

      On
        this  17 day of  July , 2006,   
Andrew Rein came before
        me, to me known and known to be the Deputy Commissioner in the
        New York City Department of Health and Mental Hygiene, who is duly authorized
        to
        execute the foregoing instrument on behalf of the City and s/he acknowledged
        to
        me that s/he executed the same for the purpose therein mentioned.

       

         
        /s/   Frank Lane

       
        NOTARY PUBLIC

       

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      

      APPENDIX
        C

      

      

      NEW
        YORK STATE DEPARTMENT OF HEALTH 

      

      

      

      
        	
                C.1

              	
                Definitions
                  and General Requirements for the Provision of Family
                  Planning and Reproductive Health Services

              
	
                C.2
                  

              	
                Requirements
                  for MCOs that Include Family Planning and Reproductive
                  Health Services in Their Benefit Package

              
	
                C.3
                  

              	
                Requirements
                  for MCOs That Do Not Include Family Planning Services and Reproductive
                  Health Services in Their Benefit
                  Package

              

      

      

      

       

      

      

      APPENDIX
        C 

      April
        1,2006 

      C-l

       

       

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

       

      C.1

      Definitions
        and General Requirements for the Provision of Family Planning and Reproductive
        Health Services

       

      1.
        Family Planning and Reproductive Health Services

       

      a)
        Family
        Planning and Reproductive Health services mean the offering, arranging and
        furnishing of those health services which enable Enrollees, including minors
        who
        may be sexually active, to prevent or reduce the incidence of unwanted
        pregnancies.

       

      i)
        Family
        Planning and Reproductive Health services include the following
        medically-necessary services, related drugs and supplies which are furnished
        or
        administered under the supervision of a physician, licensed midwife or certified
        nurse practitioner during the course of a Family Planning and Reproductive
        Health visit for the purpose of:

       

      A)
        contraception, including all FDA-approved birth control methods, devices
        such as
        insertion/removal of an intrauterine device (IUD) or insertion/removal of
        contraceptive implants, and injection procedures involving Pharmaceuticals
        such
        as Depo-Provera;

       

      B)
        emergency contraception and follow up;

       

      C)
        sterilization;

       

      D)
        screening, related diagnosis, and referral to a Participating Provider for
        pregnancy;

       

      E)
        medically-necessary induced abortions, which are procedures, either medical
        or
        surgical, that result in the termination of pregnancy. The determination
        of
        medical necessity shall include positive evidence of pregnancy, with an estimate
        of its duration.

       

      ii)
        Family Planning and Reproductive Health services include those education
        and
        counseling services necessary to render the services effective.

       

      iii)
        Family Planning and Reproductive Health services include medically-necessary
        ordered contraceptives and pharmaceuticals:

       

      A)
        For
        MMC Enrollees - The contractor is responsible for pharmaceuticals and medical
        supplies such as IUDS and Depo-Provera that must be furnished or administered
        under the supervision of a physician, licensed midwife, or certified nurse
        practitioner during the course of a Family Planning and Reproductive Health
        visit. Other pharmacy prescriptions including 

       

      

      Appendix
        C

      April
        1,2006

       C-2

      

      emergency
        contraception, medical supplies, and over the counter drugs are not the
        responsibility of the Contractor and are to be obtained when covered on the
        New
        York State list of Medicaid reimbursable drugs by the Enrollee from any
        appropriate eMedNY-enrolled health care provider of the Enrollee's
        choice.

       

      B)
        For
        FHPlus Enrollees - The Contractor, if it includes such services in its Benefit
        Package is responsible for covering prescription contraceptives, including
        emergency contraceptives, provided by a Participating pharmacy, consistent
        with
        the pharmacy benefit package as described in Appendix K. When the Contractor
        does not provide Family Planning and Reproductive Health Services, the
        Designated Third Party Contractor that covers such services for FHPlus Enrollees
        is responsible for prescription contraceptives, including emergency
        contraceptives, provided by a Participating pharmacy, consistent with the
        pharmacy benefit package as described in Appendix K. The Contractor or the
        Designated Third Party Contractor must cover at least one of every type of
        the
        following methods of contraception:

       

      I)
        Oral

      II)
        Oral,
        emergency

      III)
        Injectable

      IV)
        Transdermal

      V)
        Intravaginal

      VI)
        Intravaginal, systemic

      VII)
        Implantable

       

      b)
        When
        clinically indicated, the following services may be provided as a part of
        a
        Family Planning and Reproductive Health visit:

       

      i)
        Screening, related diagnosis, ambulatory treatment and referral as needed
        for
        dysmenorrhea, cervical cancer, or other pelvic
        abnormality/pathology.

      ii)
        Screening, related diagnosis and referral for anemia, cervical cancer,
        glycosuria, proteinuria, hypertension and breast disease.

      iii)
        Screening and treatment for sexually transmissible disease. iv) HIV testing
        and
        re- and post-test counseling.

      

      2.
        Free
        Access to Services for MMC Enrollees

       

      a)
        Free
        Access means MMC Enrollees may obtain Family Planning and Reproductive Health
        services, and HIV testing and pre-and post-test counseling when performed
        as
        part of a Family Planning and Reproductive Health encounter, from either
        the
        Contractor, if it includes such services in its Benefit Package, or from
        any
        appropriate eMedNY-enrolled
        health care provider of the Enrollee's choice. No referral from the PCP or
        approval by the Contractor is required to access such
        services.

       

      Appendix
        C

      April
        1,
        2006 

      C-3

       

      b)
        The
        Family Planning and Reproductive Health services listed above are the only
        services which are covered under the Free Access policy. Routine obstetric
        and/or gynecologic care, including hysterectomies, pre-natal, delivery and
        post-partum care are not covered under the Free Access policy, and are the
        responsibility of the Contractor.

       

      3.
        Access to Services for FHPlus Enrollees

       

      a)
        FHPlus
        Enrollees may obtain Family Planning and Reproductive Health services, and
        HIV
        testing and pre-and post-test counseling when performed as part of a Family
        Planning and Reproductive Services encounter, from either the Contractor
        or
        through the Designated Third Party Contractor, as applicable. No referral
        from
        the PCP or approval by the Contractor is required to access such
        services.

       

      b)
        The
        Contractor is responsible for routine obstetric and/or gynecologic care,
        including hysterectomies, pre-natal, delivery and post-partum care, regardless
        of whether Family Planning and Reproductive Health services are included
        in the
        Contractor's Benefit Package.

       

      Appendix
        C

      April
        1,2006

      C-4

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

       

      C.2

      Requirements
        for MCOs that Include Family Planning and Reproductive 

      Health
        Services in Their Benefit Package

       

      1.
        Notification to
        Enrollees

       

      a)
        If the
        Contractor includes Family Planning and Reproductive Health services in its
        Benefit Package (as per Appendix M of this Agreement) the Contractor must
        notify
        all Enrollees of reproductive age, including minors who may be sexually active,
        at the time of Enrollment about their right to obtain Family Planning and
        Reproductive Health services and supplies without referral or
        approval. The notification must contain the following:

       

      i)
        Information about the Enrollee's right to obtain the full range of Family
        Planning and Reproductive Health services, including HIV counseling and testing
        when performed as part of a Family Planning and Reproductive Health encounter,
        from the Contractor's Participating Provider without referral, approval or
        notification.

       

      ii)
        MMC
        Enrollees must receive notification that they also have the right to obtain
        Family Planning and Reproductive Health services in accordance with MMC's
        Free
        Access policy as defined in C.I of this Appendix.

       

      iii)
        A
        current list of qualified Participating Family Planning Providers who provide
        the full range of Family Planning and Reproductive Health services within
        the
        Enrollee's geographic area, including addresses and telephone numbers. The
        Contractor may also provide MMC Enrollees with a list of qualified
        Non-Participating providers who accept Medicaid and who provide the full
        range
        of these services.

       

      iv)
        Information that the cost of the Enrollee's Family Planning and Reproductive
        care will be fully covered, including when a MMC Enrollee obtains such services
        in accordance with MMC's Free Access policy.

       

      2.
        Billing Policy

       

      a)
        The
        Contractor must notify its Participating Providers that all claims for Family
        Planning and Reproductive services must be billed to the Contractor and not
        the
        Medicaid fee-for-service program.

       

      b)
        The
        Contractor will be charged for Family Planning and Reproductive Health services
        furnished to MMC Enrollees by eMedNY-enrolled Non-Participating Providers
        at the
        applicable Medicaid rate or fee. In such instances, Non-Participating Providers
        will bill Medicaid fee-for-service and the SDOH will issue a confidential
charge
        back to the Contractor. Such charge back mechanism will comply with all
        applicable patient confidentiality requirements.
         

      

       

      Appendix
        C

      April
        1,2006 

      C-5

      

      3.
        Consent and Confidentiality

       

      a)
        The
        Contractor will comply with federal, state, and local laws, regulations and
        policies regarding informed consent and confidentiality and ensure Participating
        Providers comply with all of the requirements set forth in Sections 17 and
        18 of
        the PHL and 10 NYCRR Section 751.9 and Part 753 relating to informed consent
        and
        confidentiality.

       

      b)
        Participating Providers may share patient information with appropriate
        Contractor personnel for the purposes of claims payment, utilization review
        and
        quality assurance, unless the provider agreement with the Contractor provides
        otherwise. The Contractor must ensure that any Enrollee's use including a
        minor's use of Family Planning and Reproductive Health services remains
        confidential and is not disclosed to family members or other unauthorized
        parties, without the Enrollee's consent to the disclosure.

       

      4.
        Informing and Standards

       

      a)
        The
        Contractor will inform its Participating Providers and administrative personnel
        about policies concerning MMC Free Access as defined in C.I of this Appendix,
        where applicable; HIV counseling and testing; reimbursement for Family Planning
        and Reproductive Health encounters; Enrollee Family Planning and Reproductive
        Health education and confidentiality.

       

      b)
        The
        Contractor will inform its Participating Providers that they must comply
        with
        professional medical standards of practice, the Contractor's practice
        guidelines, and all applicable federal, state, and local laws. These include
        but
        are not limited to, standards established by the American College of
        Obstetricians and Gynecologists, the American Academy of Family Physicians,
        the
        U.S. Task Force on Preventive Services and the New York State Child/Teen
        Health
        Program. These standards and laws recognize that Family Planning counseling
        is
        an integral part of primary and preventive care.

       

      Appendix
        C

      April
        1,
        2006 

      C-6

      

      C.3

      

      Requirements
        for MCOs That Do Not

      Include
        Family Planning Services and Reproductive Health Services in Their Benefit
        Package

       

      1.
        Requirements

       

      a)
        The
        Contractor agrees to comply with the policies and procedures stated in the
        SDOH-approved statement described in Section 2 below.

       

      b)
        Within
        ninety (90) days of signing this Agreement, the Contractor shall submit to
        the
        SDOH a policy and procedure statement that the Contractor will use to ensure
        that its Enrollees are fully informed of their rights to access a full range
        of
        Family Planning and Reproductive Health services, using the following
        guidelines. The statement must be sent to the Director, Office of Managed
        Care,
        NYS Department of Health, Corning Tower, Room 2001, Albany, NY
        12237.

       

      c)
        SDOH
        may waive the requirement in (b) above if such approved statement is already
        on
        file with SDOH and remains unchanged.

       

      2.
        Policy and Procedure Statement

       

      a)
        The
        policy and procedure statement regarding Family Planning and Reproductive
        Health
        services must contain the following:

       

      i)
        Enrollee Notification

       

      A)
        A
        statement that the Contractor will inform Prospective Enrollees, new Enrollees
        and current Enrollees that:

       

      I)
        Certain Family Planning and Reproductive Health services (such as abortion,
        sterilization and birth control) are not covered by the Contractor, but that
        routine obstetric and/or gynecologic care, including hysterectomies, pre-natal,
        delivery and post-partum care are covered by the Contractor;

       

      II)
        Such
        Family Planning and Reproductive Health Services that are not covered by
        the
        Contractor may be obtained through fee-for-service Medicaid providers for
        MMC
        Enrollees and through the Designated Third Party Contractor for FHPlus
        Enrollees;

       

      III)
        No
        referral is needed for such services, and there will be no cost to the Enrollee
        for such services.

      

      

      Appendix
        C

      April
        1,
        2006

      C-7

      

      IV)
        HIV
        counseling and testing services are available through the Contractor and
        are
        also available as part of a Family Planning and Reproductive Health encounter
        when furnished by a fee-for-service Medicaid provider to MMC Enrollees and
        through the Designated Third Party Contractor to FHPlus Enrollees; and that
        anonymous counseling and testing services are available from SDOH, Local
        Public
        Health Agency clinics and other county programs.

       

      B)
        A
        statement that this information will be provided in the following
        manner:

       

      I)
        Through the Contractor's written Marketing materials, including the Member
        Handbook. The Member Handbook and Marketing materials will indicate that
        the
        Contractor has elected not to cover certain Family Planning and Reproductive
        Health services, and will explain the right of all MMC Enrollees to secure
        such
        services through fee-for-service Medicaid from any provider/clinic which
        offers
        these services and who accepts Medicaid, and the right of all FHPlus Enrollees
        to secure such services through the Designated Third Party
        Contractor.

       

      II)
        Orally at the time of Enrollment and any time an inquiry is made regarding
        Family Planning and Reproductive Health services.

       

      Ill)
        By
        inclusion on any web site of the Contractor which includes information
        concerning its MMC or FHPlus product(s). Such information shall be prominently
        displayed and easily navigated.

       

      C)
        A
        description of the mechanisms to provide all new MMC Enrollees and FHPlus
        Enrollees with an SDOH approved letter explaining how to access Family Planning
        and Reproductive Health services and the SDOH approved list of Family Planning
        providers. This material will be furnished by SDOH and mailed to the Enrollee
        no
        later than fourteen (14) days after the Effective Date of
        Enrollment.

       

      D)
        A
        statement that if an Enrollee or Prospective Enrollee requests information
        about
        these non-covered services, the Contractor's Marketing or Enrollment
        representative or member services department will advise the Enrollee or
        Prospective Enrollee as follows:

       

      I)
        Family
        Planning and Reproductive Health services such as abortion, sterilization
        and
        birth control are not covered by the Contractor and that only routine obstetric
        and/or gynecologic care, including hysterectomies, pre-natal, delivery and
        post-partum care are the responsibility of the Contractor.

       

      Appendix
        C

      April
        1,
        2006

      C-8

      

      II)
        MMC
        Enrollees can use their Medicaid card to receive these non-covered services
        from
        any doctor or clinic that provides these services and accepts Medicaid. FHPlus
        Enrollees can receive these non-covered services through the Designated Third
        Party Contractor using either the Designated Third Party Contractor's
        identification card or the Contractor's card which shall include the Enrollee's
        Client Identification Number.

       

      Ill)
        Each
        MMC Enrollee and Prospective MMC Enrollee who calls will be mailed a copy
        of the
        SDOH approved letter explaining the Enrollee's right to receive these
        non-covered services, and an SDOH approved list of Family Planning Providers
        who
        participate in Medicaid in the Enrollee's community. These materials will
        be
        mailed within two (2) business days of the contact.

       

      IV)
        The
        Contractor will provide the name and phone number of the Designated Third
        Party
        Contractor or such other organization designated by the SDOH to provide such
        services to FHPlus Enrollees and Prospective FHPlus Enrollees. It is the
        responsibility of the Designated Third Party Contractor or such other
        organization designated by the .SDOH to mail to each FHPlus Enrollee or
        Prospective FHPlus Enrollee who calls, a copy of the SDOH approved letter
        explaining the Enrollee's right to receive such services, and an SDOH approved
        list of Family Planning Providers from which the Enrollee may access family
        planning services. The Designated Third Party Contractor or such other
        organization designated by the SDOH is responsible for mailing these materials
        within fourteen (14) days of notice by the Contractor of a new Enrollee in
        the
        Contractor's FHPlus product.

       

      V)
        Enrollees can call the Contractor's member services number for further
        information about how to obtain these non-covered services. MMC Enrollees
        can
        also call the New York State Growing-Up-Healthy Hotline (1-800-522-5006)
        to
        request a copy of the list of Medicaid Family Planning Providers. FHPlus
        Enrollees can also call the Designated Third Party Contractor or such other
        organization designated by the SDOH for a list of Family Planning
        providers.

       

      E)
        The
        procedure for maintaining a manual log of all requests for such information,
        including the date of the call, the Enrollee's client identification number
        (CIN), and the date the SDOH approved letter and SDOH or LDSS approved list
        were
        mailed, where applicable. The Contractor will review this log monthly and
        upon
        request, submit a copy to SDOH.

       

      ii)
        Participating Provider and Employee Notification

       

      Appendix
        C

      April
        1,
        2006 

      C-9

      

      A)
        A
        statement that the Contractor will inform its Participating Providers and
        administrative personnel about Family Planning and Reproductive Health policies
        under MMC Free Access, as defined in C. 1 of this Appendix, and/or the FHPlus
        Designated Third Party Contractor for FHPlus Enrollees, HIV counseling and
        testing; reimbursement for Family Planning and Reproductive Health encounters;
        Enrollee Family Planning and Reproductive Health education and
        confidentiality.

       

      B)
        A
        statement that the Contractor will inform its Participating Providers that
        they
        must comply with professional medical standards of practice, the Contractor's
        practice guidelines, and all applicable federal, state, and local laws. These
        include but are not limited to, standards established by the American College
        of
        Obstetricians and Gynecologists, the American Academy of Family Physicians,
        the
        U.S. Task Force on Preventive Services and the New York State Child/Teen
        Health
        Program. These standards and laws recognize that Family Planning counseling
        is
        an integral part of primary and preventive care.

       

      C)
        The
        procedure(s) for informing the Contractor's Participating primary care
        providers, family practice physicians, obstetricians, gynecologists and
        pediatricians that the Contractor has elected not to cover certain Family
        Planning and Reproductive Health services, but that routine obstetric and/or
        gynecologic care, including hysterectomies, pre-natal, delivery and post-partum
        care are covered; and that Participating Providers may provide, make referrals,
        or arrange for non-covered services in accordance with MMC's Free Access
        policy,
        as defined in C.I of this Appendix, and/or through the SDOH-contracted
        Designated Third Party for FHPlus Enrollees.

       

      D)
        A
        description of the mechanisms to inform the Contractor's Participating Providers
        that:

       

      I)
        if
        they also participate in the fee-for-service Medicaid program and they render
        non-covered Family Planning and Reproductive Health services to MMC Enrollees,
        they do so as a fee-for-service Medicaid practitioner, independent of the
        Contractor.

       

      II)
        if
        they also participate with the FHPlus Designated Third Party Contractor and
        they
        render non-covered Family Planning and Reproductive Health Services to FHPlus
        Enrollees, they do so as a participating provider with the Designated Third
        Party Contractor, independent of the Contractor.

       

      E)
        A
        description of the mechanisms to inform Participating Providers that, if
        requested by the Enrollee, or, if in the provider's best professional judgment,
        certain Family Planning and Reproductive Health services not offered through
        the
        Contractor are medically indicated in accordance with generally accepted
        standards of professional practice, an appropriately trained professional
        should
        so advise the Enrollee and either:

       

      Appendix
        C

      April
        1,2006 

      C-10

      

       

      I)
        offer
        those services to MMC Enrollees on a fee-for-service basis as an eMedNY-enrolled
        provider, or to FHPlus Enrollees as a Participating Provider of the Designated
        Third Party Contractor; or

       

      II)
        provide MMC Enrollees with a copy of the SDOH approved list of Medicaid Family
        Planning Providers, and/or provide FHPlus Enrollees with the name and number
        of
        the Designated Third Party Contractor, or

       

      III)
        give
        Enrollees the Contractor's member services number to call to obtain either
        the
        list of Medicaid Family Planning Providers or the name and number of the
        Designated Third Party Contractor, as applicable.

       

      F)
        A
        statement that the Contractor acknowledges that the exchange of medical
        information, when indicated in accordance with generally accepted standards
        of
        professional practice, is necessary for the overall coordination of Enrollees'
        care and assist Primary Care Providers in providing the highest quality care
        to
        the. Contractor's Enrollees. The Contractor must also acknowledge that medical
        record information maintained by Participating Providers may include information
        relating to Family Planning and Reproductive Health services provided under
        the
        fee-for-service Medicaid program or under the Designated Third Party contract
        with SDOH.

       

      iii)
        Quality Assurance Initiatives

       

      A)
        A
        statement that the Contractor will submit any materials to be furnished to
        Enrollees and providers relating to access to non-covered Family Planning
        and
        Reproductive Health services to SDOH, Office of Managed Care for its review
        and
        approval before issuance. Such materials include, but are not limited to,
        Member
        Handbooks, provider manuals, and Marketing materials.

       

      B)
        A
        description of monitoring mechanisms the Contractor will use to assess the
        quality of the information provided to Enrollees.

       

      C)
        A
        statement that the Contractor will prepare a monthly list of MMC Enrollees
        who
        have been sent a copy of the SDOH approved letter and the SDOH approved list
        of
        Family Planning providers, and a list of FHPlus Enrollees who have been provided
        with the name and telephone number of the Designated Third Party Contractor.
        This information will be available to SDOH upon request.

       

      D)
        A
        statement that the Contractor will provide all new employees with a copy
        of
        these policies. A statement that the Contractor's orientation programs will
        include
        a
        thorough discussion of all aspects of these policies and procedures and that
        annual retraining programs for all employees will be conducted to ensure
        continuing compliance with these policies.

       

      Appendix
        C

      April
        1,2006 

      C-ll

      

       

      E)
        A
        description of the mechanisms to provide the Designated Third Party Contractor,
        SDOH, or SDOH's subcontractor with a monthly listing of all FHPlus Enrollees
        within seven (7) days of receipt of the Contractor's monthly Enrollment Roster
        and any subsequent updates or adjustments. A copy of each file will also
        be
        provided simultaneously to the SDOH. A description of mechanisms to provide
        SDOH
        or SDOH's subcontractor with a list of prospective FHPlus Enrollees within
        two
        (2) business days of the prospective Enrollee encounter, and a list of Enrollees
        who call to request information within two (2) business days of an Enrollee's
        request.

       

      3.
        Consent and Confidentiality

       

      a)
        The
        Contractor must comply with federal, state, and local laws, regulations and
        policies regarding informed consent and confidentiality and ensure Participating
        Providers comply with all of the requirements set forth in Sections 17 and
        18 of
        the PHL and 10 NYCRR § 751.9 and Part 753 relating to informed consent and
        confidentiality.

       

      b)
        Participating Providers and/or the Designated Third Party Contractor Providers,
        may share patient information with appropriate Contractor personnel for the
        purposes of claims payment, utilization review and quality assurance, unless
        the
        provider agreement with the Contractor provides otherwise. The Contractor
        must
        ensure that any Enrollee's use including a minor's use of Family Planning
        and
        Reproductive Health services remains confidential and is not disclosed to
        family
        members or other unauthorized parties, without the Enrollee's consent to
        the
        disclosure.

      

      

      APPENDIX
        C

      April
        1,2006

      C-12Exhibit 10.3

     

      
        

      

    

    Back
      to Form 8-K

    Exhibit
      10.3

     

     

    

      APPENDIX
        X

      [Amendment
        Number 1]

      

      

      

      Agency
        Code 12000  
        Contract
        No. C020454

      Period
        4/1/06-9/30/08  
        Funding
        Amount for Period Based
        on approved capitation rates

      

       

      This
        is
        an AGREEMENT between THE STATE OF NEW YORK, acting by and through The
        New York State Department of Health,
        having
        its principal office at Corning
        Tower, Room 2001, Empire State Plaza, Albany NY 12237,
        (hereinafter referred to as the STATE), and WellCare
        of New York, Inc.,
        (hereinafter referred to as the CONTRACTOR), to modify Contract
        Number C020454
        as set
        forth below. The effective date of these modifications is April 1, 2006,
        unless
        otherwise noted below.

       

      1.
        Amend
        Section 1,: "Definitions," the definition for "Designated Third Party
        Contractor," to read as follows

       

      "Designated
        Third Party Contractor"
        means a
        MCO with which the SDOH has contracted to provide Family Planning and
        Reproductive Health Services for FHPlus Enrollees of a MCO that does not
        include
        such services in its Benefit Package or, for the purpose of this Agreement,
        the
        New York State Medicaid fee-for-service program and its participating providers
        and subcontractors.

       

      2.
        The
        attached Appendix
        C,
        "New
        York State Department of Health Requirements for the

      Provision
        of Family Planning and Reproductive Health," is substituted for the period
        beginning April 1,2006.

       

      3.
        Effective
        January 1, 2006, Item Number 10 in Section K.I, "Prepaid Benefit Package,"
        of
        Appendix K, "Prepaid Benefit Package Definitions of Covered and Non-Covered
        Services," is amended
        to read as follows:

       

      
        	
                *

              	
                Covered
                  Services

              	
                MMC
                  Non-SSI

              	
                MMC
                  SSI

              	
                MFFS

              	
                FHPlus**

              
	
                10.

              	
                Prescription
                  and Non-Prescription (OTC) Drugs, Medical Supplies, and Enteral
                  Formula

              	
                Pharmaceuticals
                  and medical supplies routinely furnished or administered as part
                  of a
                  clinic or office visit, except Risperdal Consta [see Appendix K.3,
                  2.b)xi)
                  of this Agreement]

              	
                Pharmaceuticals
                  and medical supplies routinely furnished or administered as part
                  of a
                  clinic or office visit, except Risperdal Consta [see Appendix K.3,2.b)
                  xi)
                  of this Agreement]

              	
                Covered
                  outpatient drugs from the list of Medicaid reimbursable prescription
                  drugs, subject to any applicable co-payments

              	
                Covered,
                  may be limited to generic. Vitamins (except to treat an illness
                  or
                  condition), OTCs, and medical supplies are not
                  covered

              

      

       

      4.
        Effective
        January 1, 2006, Subsection xi) is added to Subsection 2., "Non-Covered
        Behavioral Health Services," b) "Mental Health Services," of Section K.3,
        "Medicaid Managed Care Prepaid Benefit Package Definitions of Non-Covered
        Services," in Appendix K, "Prepaid Benefit Package Definitions of Covered
        and
        Non-Covered Services." and reads as follows:

       

      xi)
        Risperdal Consta, an injectable mental health drug used for management of
        patients with schizophrenia, furnished as part of a clinic or office
        visit.

       

      5.
        The
        attached Appendix L,
        "Approved Capitation Payment Rates." is substituted for the period beginning
        April 1. 2006.

       

      All
        other
        provisions of said AGREEMENT shall remain in full force and effect.

       

      IN
        WITNESS WHEREOF, the parties hereto have executed this AGREEMENT as of the
        dates
        appearing under their signatures.

      
        	
                 

                CONTRACTOR
                  SIGNATURE

              	 	
                 

                STATE
                  AGENCY SIGNATURE

              
	
                 

                By:
                  /s/ Todd S.
                  Farha             
                  

              	 	
                 

                By:  /s/
                  Donna Frescatore       
                  

              
	
                TODD
                  S. FARHA

              	 	
                DONNA
                  FRESCATORE

              
	
                 

                Title:
                  PRESIDENT & CEO

              	 	
                 

                Title:
                  DEPUTY DIRECTOR, OMC

              
	
                 

                Date:
                  6/19/06

              	 	
                 

                Date:
                  7/7/06

              
	 	 	
                State
                  Agency Certification:

                In
                  addition to the acceptance of this contract, I also certify that
                  original
                  copies of this signature page will be attached to all other exact
                  copies
                  of this contract

              

      

       

      

      STATE
        OF
        FLORIDA  

      SS.:

      County
        of
HILLSBOROUGH  

       

      On
        the
19th 
        day of
June 
        2006,
        before me personally appeared Todd
        S. Farha   to
        me
        known, who being by me duly sworn, did depose and
        say
        that he/she resides at Tampa,
        Florida,
        that
        he/she is the President
        & CEO
        of
WellCare
        of New York, Inc.,
        the
corporation
        described herein which executed the foregoing instrument; and that he/she
        signed
his/her
        name thereto by order of the board of directors of said
        corporation.

      

      (Notary)

       

       
        /s/  Sara Gallo    

      Sara
        Gallo

      Date: 
6/19/06

      

      

      
        	
                 

                STATE
                  COMPTROLLER’S SIGNATURE

                 
                  /s/  
                  Illegible          
                   

              	
                 

                 

                Title:
                  State Comptroller      

              
	 	
                 

                Date:
                  7/29/06      

              

      

       

      

       

         

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      

      Appendix
        C

      

      

      New
        York State Department of Health 

      Requirements
        for the Provision of 

      Family
        Planning and Reproductive Health Services

       

      
        	 	
                C.I
                  

              	
                Definitions
                  and General Requirements for the Provision of Family Planning and
                  Reproductive Health
                  Services

              

      

       

      
        	 	
                C.2
                  

              	
                Requirements
                  for MCOs that Include Family Planning and Reproductive Health Services
                  in
                  Their Benefit Package

              

      

       

      
        	 	
                C.3
                  

              	
                Requirements
                  for MCOs That Do Not Include Family Planning Services and Reproductive
                  Health Services in Their Benefit
                  Package

              

      

       

       

       

      APPENDIX
        C 

      April
        1,2006 

      C-l

       

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      C.I

      Definitions
        and General Requirements for the Provision of Family Planning and Reproductive
        Health Services

       

      1. Family
        Planning and Reproductive Health Services

       

      a)
        Family
        Planning and Reproductive Health services mean the offering, arranging and
        famishing of those health services which enable Enrollees, including minors
        who
        may be sexually active, to prevent or reduce the incidence of unwanted
        pregnancies.

       

      i)
        Family
        Planning and Reproductive Health services include the following
        medically-necessary services, related drugs and supplies which are furnished
        or
        administered under the supervision of a physician, licensed midwife or certified
        nurse practitioner during the course of a Family Planning and Reproductive
        Health visit for the purpose of;

       

      A)
        contraception, including all FDA-approved birth control methods, devices
        such as
        insertion/removal of an intrauterine device (IUD) or insertion/removal of
        contraceptive implants, and injection procedures involving Pharmaceuticals
        such
        as Depo-Provera;

       

      B)
        emergency contraception and follow up;

       

      C)
        sterilization;

       

      D)
        screening, related diagnosis, and referral to a Participating Provider for
        pregnancy;

       

      E)
        medically-necessary induced abortions, which are procedures, either medical
        or
        surgical, that result in the termination of pregnancy. The determination
        of
        medical necessity shall include positive evidence of pregnancy, with an estimate
        of its duration.

       

      ii)
        Family Planning and Reproductive Health services include those education
        and
        counseling services necessary to render the services effective.

       

      iii)
        Family Planning and Reproductive Health services include medically-necessary
        ordered contraceptives and pharmaceuticals:

       

      A)
        For
        MMC Enrollees - The contractor is responsible for pharmaceuticals and medical
        supplies such as IUDS and Depo-Provera that must be furnished or administered
        under the supervision of a physician, licensed midwife, or certified nurse
        practitioner during the course of a Family Planning and Reproductive Health
        visit. Other pharmacy prescriptions including

      

      APPENDIX
        C

      April
        1,
        2006

      C-2

      

      emergency
        contraception, medical supplies, and over the counter drugs are not the
        responsibility of the Contractor and are to be obtained when covered on the
        New
        York State list of Medicaid reimbursable drugs by the Enrollee from any
        appropriate eMedNY-enrolled health care provider of the Enrollee's
        choice.

       

      B)
        For
        FHPlus Enrollees - The Contractor, if it includes such services in its Benefit
        Package is responsible for covering prescription contraceptives, including
        emergency contraceptives, provided by a Participating pharmacy, consistent
        with
        the pharmacy benefit package as described in Appendix K. When the Contractor
        does not provide Family Planning and Reproductive Health Services, the
        Designated Third Party Contractor that covers such services for FHPlus Enrollees
        is responsible for prescription contraceptives, including emergency
        contraceptives, provided by a Participating pharmacy, consistent with the
        pharmacy benefit package as described in Appendix K. The Contractor or the
        Designated Third Party Contractor must cover at least one of every type of
        the
        following methods of contraception:

       

      I)
        Oral

      II)
        Oral,
        emergency

      III)
        Injectable

      IV)
        Transdermal

      V)
        Intravaginal

      VI)
        Intravaginal, systemic

      VII)
        Implantable

       

      b)
        When
        clinically indicated, the following services may be provided as a part of
        a
        Family Planning and Reproductive Health visit;

       

      i)
        Screening, related diagnosis, ambulatory treatment and referral as needed
        for
        dysmenorrhea, cervical cancer, or other pelvic
        abnormality/pathology.

       

      ii)
        Screening, related diagnosis and referral for anemia, cervical cancer,
        glycosuria, proteinuria, hypertension and breast disease.

       

      iii)
        Screening and treatment for sexually transmissible disease. 

      iv)
        HIV
        testing and pre- and post-test counseling. 

       

      2. Free
        Access to Services for MMC Enrollees

       

      a)
        Free
        Access means MMC Enrollees may obtain Family Planning and Reproductive Health
        services, and HIV testing and pre-and post-test counseling when performed
        as
        part of a Family Planning and Reproductive Health encounter, from either
        the
        Contractor, if it includes such services in its Benefit Package, or from
        any
        appropriate

      APPENDIX
        C

      April
        1,
        2006

       

      C-3

       

      

      eMedNY-enrolled
        health care provider of the Enrollee's choice. No referral from the PCP or
        approval by the Contractor is required to access such services.

       

      b)
        The
        Family Planning and Reproductive Health services listed above are the only
        services which are covered under the Free Access policy. Routine obstetric
        and/or gynecologic care, including hysterectomies, pre-natal, delivery and
        post-partum care are not covered under the Free Access policy, and are the
        responsibility of the Contractor.

       

      3. Access
        to Services for FHPlus Enrollees

       

      a)
        FHPlus
        Enrollees may obtain Family Planning and Reproductive Health services, and
        HIV
        testing and pre-and post-test counseling when performed as part of a Family
        Planning and Reproductive Services encounter, from either the Contractor
        or
        through the Designated Third Party Contractor, as applicable. No referral
        from
        the PCP or approval by the Contractor is required to access such
        services.

       

      b)
        The
        Contractor is responsible for routine obstetric and/or gynecologic care,
        including hysterectomies, pre-natal, delivery and post-partum care, regardless
        of whether Family Planning and Reproductive Health services are included
        in the
        Contractor's Benefit Package.

      

      

      

      APPENDIX
        C

      April
        1,
        2006

      C-4

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      C.2

       

      Requirements
        for MCOs that Include Family Planning and Reproductive Health Services in
        Their
        Benefit Package

       

      1. Notification
        to Enrollees

       

      a)
        If the
        Contractor includes Family Planning and Reproductive Health services in its
        Benefit Package (as per Appendix M of this Agreement) the Contractor must
        notify
        all Enrollees of reproductive age, including minors who may be sexually active,
        at the time of Enrollment about their right to obtain Family Planning and
        Reproductive Health services and supplies without referral or approval. The
        notification must contain the following:

       

      i)
        Information about the Enrollee's right to obtain the full range of Family
        Planning and Reproductive Health services, including HIV counseling and testing
        when performed as part of a Family Planning and Reproductive Health encounter,
        from the Contractor's Participating Provider without referral, approval or
        notification.

       

      ii)
        MMC
        Enrollees must receive notification that they also have the right to obtain
        Family Planning and Reproductive Health services in accordance with MMC's
        Free
        Access policy as defined in C.I of this Appendix.

       

      iii)
        A
        current list of qualified Participating Family Planning Providers who provide
        the full range of Family Planning and Reproductive Health services within
        the
        Enrollee's geographic area, including addresses and telephone numbers. The
        Contractor may also provide MMC Enrollees with a list of qualified
        Non-Participating providers who accept Medicaid and who provide the full
        range
        of these services.

       

      iv)
        Information that the cost of the Enrollee's Family Planning and Reproductive
        care will be fully covered, including when a MMC Enrollee obtains such services
        in accordance with MMC's Free Access policy.

       

      2. Billing
        Policy

       

      a)
        The
        Contractor must notify its Participating Providers that all claims for Family
        Planning and Reproductive services must be billed to the Contractor and not
        the
        Medicaid fee-for-service program.

       

      b)
        The
        Contractor will be charged for Family Planning and Reproductive Health services
        furnished to MMC Enrollees by eMedNY-enrolled Non-Participating Providers
        at the
        applicable Medicaid rate or fee. In such instances, Non-Participating Providers
        will bill Medicaid fee-for-service and the SDOH will issue a
        confidential

      

      

      

      APPENDIX
        C 

      April
        1,2006

      C-5

       

      

      charge
        back to the Contractor. Such charge back mechanism will comply with all
        applicable patient confidentiality requirements.

       

      3. Consent
        and Confidentiality

       

      a)
        The
        Contractor will comply with federal, state, and local laws, regulations and
        policies regarding informed consent and confidentiality and ensure Participating
        Providers comply with all of the requirements set forth in Sections 17 and
        18 of
        the PHL and 10 NYCRR Section 751.9 and Part 753 relating to informed consent
        and
        confidentiality:

       

      b)
        Participating Providers may share patient information with appropriate
        Contractor personnel for the purposes of claims payment, utilization review
        and
        quality assurance, unless the provider agreement with the Contractor provides
        otherwise. The Contractor must ensure that any Enrollee's use including a
        minors
        use of Family Planning and Reproductive Health services remains confidential
        and
        is not disclosed to family members or other unauthorized parties, without
        the
        Enrollee's consent to the disclosure.

       

      4. Informing
        and Standards

       

      a)
        The
        Contractor will inform its Participating Providers and administrative personnel
        about policies concerning MMC Free Access as defined in C.I of this Appendix,
        where applicable; HIV counseling and testing; reimbursement for Family Planning
        and Reproductive Health encounters; Enrollee Family Planning and Reproductive
        Health education and confidentiality.

       

      b)
        The
        Contractor will inform its Participating Providers that they must comply
        with
        professional medical standards of practice, the Contractors practice guidelines,
        and all applicable federal, state, and local laws. These include but are
        not
        limited to, standards established by the American College of Obstetricians
        an(l
        Gynecologists, the American Academy of Family Physicians, the U.S. Task Force
        on
        Preventive Services and the New York State Child/Teen Health Program. These
        standards and laws recognize that Family Planning counseling is an integral
        part
        of primary and preventive care.

      

       

      

      APPENDIX
        C

      April
        1,
        2006

      C-6

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      C.3

      

      Requirements
        for MCOs That Do Not 

      Include
        Family Planning Services and Reproductive Health Services in
        Their

      Benefit
        Package

       

      1. Requirements

       

      a)
        The
        Contractor agrees to comply with the policies and procedures stated in the
        SDOH-approved statement described in Section 2 below.

       

      b)
        Within
        ninety (90) days of signing this Agreement, the Contractor shall submit to
        the
        SDOH a policy and procedure statement that the Contractor will use to ensure
        that its Enrollees are fully informed of their rights to access a full range
        of
        Family Planning and Reproductive Health services, using the following
        guidelines. The statement must be sent to the Director, Office of Managed
        Care,
        NYS Department of Health, Corning Tower, Room 2001, Albany, NY
        12237.

       

      c)
        SDOH
        may waive the requirement in (b) above if such approved statement is already
        on
        file with SDOH and remains unchanged.

       

      2. Policy
        and Procedure Statement

       

      a)
        The
        policy and procedure statement regarding Family Planning and Reproductive
        Health
        services must contain the following:

       

      i)
        Enrollee Notification

       

      A)
        A
        statement that the Contractor will inform Prospective Enrollees, new Enrollees
        and current Enrollees that:

       

      I)
        Certain Family Planning and Reproductive Health services (such as abortion,
        sterilization and birth control) are not covered by the Contractor, but that
        routine obstetric and/or gynecologic care, including hysterectomies, pre-natal,
        delivery and post-partum care are covered by the Contractor;

       

      II)
        Such
        Family Planning and Reproductive Health Services that are not covered by the
        Contractor may be obtained through fee-for-service Medicaid providers for
        MMC
        Enrollees and through the Designated Third Party Contractor for FHPlus
        Enrollees;

       

      III)
        No
        referral is needed for such services, and there will be no cost to the Enrollee
        for such services.

      

      

      APPENDIX
        C

      April
        1,
        2006

      C-7

      IV)
        HIV
        counseling and testing services are available through the Contractor and
        are
        also available as part of a Family Planning and Reproductive Health encounter
        when furnished by a fee-for-service Medicaid provider to MMC Enrollees and
        through the Designated Third Party Contractor to FHPlus Enrollees; and that
        anonymous counseling and testing services are available from SDOH, Local
        Public
        Health Agency clinics and other county programs.

       

      B)
        A
        statement that this information will be provided in the following
        manner:

       

      I)
        Through the Contractor's written Marketing materials, including the Member
        Handbook. The Member Handbook and Marketing materials will indicate that
        the
        Contractor has elected not to cover certain Family Planning and Reproductive
        Health services, and will explain the right of all MMC Enrollees to secure
        such
        services through fee-for-service Medicaid from any provider/clinic which
        offers
        these services and who accepts Medicaid, and the right of all FHPlus Enrollees
        to secure such services through the Designated Third Party
        Contractor.

       

      II)
        Orally at the time of Enrollment and any time an inquiry is made regarding
        Family Planning and Reproductive Health services.

       

      Ill)
        By
        inclusion on any web site of the Contractor which includes information
        concerning its MMC or FHPlus product(s). Such information shall be prominently
        displayed and easily navigated.

       

      C)
        A
        description of the mechanisms to provide all new MMC Enrollees and FHPlus
        Enrollees with an SDOH approved letter explaining how to access Family Planning
        and Reproductive Health services and the SDOH approved list of Family Planning
        providers. This material will be furnished by SDOH and mailed to the Enrollee
        no
        later than fourteen (14) days after the Effective Date of
        Enrollment.

       

      D)
        A
        statement that if an Enrollee or Prospective Enrollee requests information
        about
        these non-covered services, the Contractor's Marketing or Enrollment
        representative or member services department will advise the Enrollee or
        Prospective Enrollee as follows:

       

      I)
        Family
        Planning and Reproductive Health services such as abortion, sterilization
        and
        birth control are not covered by the Contractor and that only routine obstetric
        and/or gynecologic care, including hysterectomies, pre-natal, delivery and
        post-partum care are the responsibility of the Contractor.

      

      

      APPENDIX
        C

      April
        1,
        2006

      C-8

       

      

      II)
        MMC
        Enrollees can use their Medicaid card to receive these non-covered services
        from
        any doctor or clinic that provides these services and accepts Medicaidj FHPlus
        Enrollees can receive these non-covered services through the Designated Third
        Party Contractor using either the Designated Third Party Contractor's
        identification card or the Contractor's card which shall include the Enrollee's
        Client Identification Number.

       

      III)
        Each
        MMC Enrollee and Prospective MMC Enrollee who calls will be mailed a copy
        of the
        SDOH approved letter explaining the Enrollee's right to receive these
        non-covered services, and an SDOH approved list of Family Planning Providers
        who
        participate in Medicaid in the Enrollee's community. These" materials will
        be
        mailed within two (2) business days of the contact.

       

      IV)
        The
        Contractor will provide the name and phone number of the

      Designated
        Third Party Contractor or such other organization designated by the SDOH
        to
        provide such services to FHPlus Enrollees and Prospective FHPlus Enrollees.
        It
        is the responsibility of the Designated Third Party Contractor or such other
        organization designated by the SDOH to mail to each FHPlus Enrollee or
        Prospective FHPlus Enrollee who calls, a copy of the SDOH approved letter
        explaining the Enrollee's right to receive such services, and an SDOH approved
        list of Family Planning Providers from which the Enrollee may access family
        planning services. The Designated Third Party Contractor or such other
        organization designated by the SDOH is responsible for mailing these materials
        within fourteen (14) days of notice by the Contractor of a new Enrollee in
        the
        Contractor's FHPlus product.

       

      V)
        Enrollees can call the Contractor's member services number for further
        information about how to obtain these non-covered services. MMC Enrollees
        can
        also call the New York State Growing-Up-Healthy Hotline (1-800-522-5006)
        to
        request a copy of the list of Medicaid Family Planning Providers. FHPlus
        Enrollees can also call the Designated Third Party Contractor or such other
        organization designated by the SDOH for a list of Family Planning
        providers.

       

      E)
        The
        procedure for maintaining a manual log of all requests for such information,
        including the date of the call, the Enrollee's client identification number
        (CIN), and the date the SDOH approved letter and SDOH or LDSS approved list
        were
        mailed, where applicable. The Contractor will review this log monthly and
        upon
        request, submit a copy to SDOH.

      

      APPENDIX
        C

      April
        1,
        2006 

      C-9

      

      ii)
        Participating Provider and Employee Notification

       

      A)
        A
        statement that the Contractor will inform its Participating Providers and
        administrative personnel about Family Planning and Reproductive Health policies
        under MMC Free Access, as defined in C.I of this Appendix, and/or the FHPlus
        Designated Third Party Contractor for FHPlus Enrollees, HIV counseling and
        testing; reimbursement for Family Planning and Reproductive Health encounters;
        Enrollee Family Planning and Reproductive Health education and
        confidentiality.

       

      B)
        A
        statement jthat the Contractor will inform its Participating Providers that
        they
        must comply with professional medical standards of practice, the Contractor's
        practice guidelines, and all applicable federal, state, and local laws. These
        include but are not limited to, standards established by the American College
        of
        Obstetricians and Gynecologists, the American Academy of Family Physicians,
        the
        U.S. Task Force on Preventive Services and the New York State Child/Teen
        Health
        Program. These standards and laws recognize that Family Planning counseling
        is
        an integral part of primary and preventive care.

       

      C)
        The
        procedure(s) for informing the Contractor's Participating primary care
        providers, family practice physicians, obstetricians, gynecologists and
        pediatricians that the Contractor has elected not to cover certain Family
        Planning and Reproductive Health services, but that routine obstetric and/or
        gynecologic care, including hysterectomies, pre-natal, delivery and post-partum
        care are covered; and that Participating Providers may provide, make referrals,
        or arrange for non-covered services in accordance with MMC's Free Access
        policy,
        as defined in C.I of this Appendix, and/or through the SDOH-contracted
        Designated Third Party for FHPlus Enrollees.

       

      D)
        A
        description of the mechanisms to inform the Contractor's Participating Providers
        that:

       

      I)
        if
        they also participate in the fee-for-service Medicaid program and they render
        non-covered Family Planning and Reproductive Health services to MMC Enrollees,
        they do so as a fee-for-service Medicaid practitioner, independent of the
        Contractor.

       

      II)
        if
        they also participate with the FHPlus Designated Third Party Contractor and
        they
        render non-covered Family Planning and Reproductive Health Services to FHPlus
        Enrollees, they do so as a participating provider with the Designated Third
        Party Contractor, independent of the Contractor.

       

      E)
        A
        description of the mechanisms to inform Participating Providers that, if
        requested by the Enrollee, or, if in the provider's best professional
        judgment,

       

       

      APPENDIX
        C

      April
        1,
        2006

      C-10

      

      certain
        Family Planning and Reproductive Health services not offered through the
        Contractor are medically indicated in accordance with generally accepted
        standards of professional practice, an appropriately trained professional
        should
        so advise the Enrollee and either:

       

      I)
        offer
        those services to MMC Enrollees on a fee-for-service basis as an eMedNY-enrolled
        provider, or to FHPlus Enrollees as a Participating Provider of the Designated
        Third Party Contractor; or

       

      II)
        provide MMC Enrollees with a copy of the SDOH approved list of Medicaid Family
        Planning Providers, and/or provide FHPlus Enrollees with the name and number
        of
        the Designated Third Party Contractor, or

       

      III)
        give
        Enrollees the Contractor's member services number to call to obtain either
        the
        list of Medicaid Family Planning Providers or the name and number of the
        Designated Third Party Contractor, as applicable.

       

      F)
        A
        statement that the Contractor acknowledges that the exchange of medical
        information, when indicated in accordance with generally accepted standards
        of
        professional practice, is necessary for the overall coordination of Enrollees'
        care and assist Primary Care Providers in providing the highest quality care
        to
        the Contractor's Enrollees. The Contractor must also acknowledge that medical
        record information maintained by Participating Providers may include information
        relating to Family Planning and Reproductive Health services provided under
        the
        fee-for-service Medicaid program or under the Designated Third Party contract
        with SDOH.

       

      iii)
        Quality Assurance Initiatives

       

      A)
        A
        statement that the Contractor will submit any materials to be furnished to
        Enrollees and providers relating to access to non-covered Family Planning
        and
        Reproductive Health services to SDOH, Office of Managed Care for its review
        and
        approval before issuance. Such materials include, but are not limited to,
        Member
        Handbooks, provider manuals, and Marketing materials.

       

      B)
        A
        description of monitoring mechanisms the Contractor will use to assess the
        quality of the information provided to Enrollees.

       

      C)
        A
        statement that the Contractor will prepare a monthly list of MMC Enrollees
        who
        have been sent a copy of the SDOH approved letter and the SDOH approved list
        of
        Family Planning providers, and a list of FHPlus Enrollees who have been provided
        with the name and telephone number of the Designated Third Party Contractor.
        This information will be available to SDOH upon request.

      

      

      APPENDIX
        C

      April
        1,
        2006

      C-11

      

      D)
        A
        statement that the Contractor will provide all new employees with a copy
        of
        these policies. A statement that the Contractor's orientation programs will
        include a thorough discussion of all aspects of these policies and procedures
        and that annual retraining programs for all employees will be conducted to
        ensure continuing compliance with these policies.

       

      E)
        A
        description of the mechanisms to provide the Designated Third Party Contractor,
        SDOH, or SDOH's subcontractor with a monthly listing of all FHPlus Enrollees
        within seven (7) days of receipt of the Contractor's monthly Enrollment Roster
        and any subsequent updates or adjustments. A copy of each file will also
        be
        provided simultaneously to the SDOH. A description of mechanisms to provide
        SDOH
        or SDOH's subcontractor with a list of prospective FHPlus Enrollees within
        two
        (2) business days of the prospective Enrollee encounter, and a list of Enrollees
        who call to request information within two (2) business days of an Enrollee's
        request.

       

      3. Consent
        and Confidentiality

       

      a)
        The
        Contractor must comply with federal, state, and local laws, regulations and
        policies regarding informed consent and confidentiality and ensure Participating
        Providers comply with all of the requirements set forth in Sections 17 and
        18 of
        the PHL and 10 NYCRR § 751.9 and Part 753 relating to informed consent and
        confidentiality.

       

      b)
        Participating Providers and/or the Designated Third Party Contractor Providers,
        may share patient information with appropriate Contractor personnel for the
        purposes of claims payment, utilization review and quality assurance, unless
        the
        provider agreement with the Contractor provides otherwise. The Contractor
        must
        ensure that any Enrollee's use including a minor's use of Family Planning
        and
        Reproductive Health services remains confidential and is not disclosed to
        family
        members or other unauthorized parties, without the Enrollee's consent to
        the
        disclosure.

      

      
        APPENDIX
          C

        April
          1,
          2006

        C-12

      

      
        
          
          

        

        
          
          

          
            

          

        

        
          
          

        

      

      

        APPENDIX
          L

         

        Approved
          Capitation Payment Rates

         

        

         

        

         

        

         

        

        APPENDIX
          L

        April
          1,
          2006 

        L-l

         

        
           

          
            
              
              

            

            
              
              

              
                

              

            

            
              
              

            

          
5

         

         

        WELLCARE
          OF NEW YORK, INC.

         

        Medicaid
          Managed Care Rates

         

        

        
          	
                  MMIS
                    ID #: 01182503  

                	
                  Effective
                    Date: 04/01/06 

                
	
                  Approved
                    by DOB: Yes

                	
                  Region:
                    Northeast

                
	 	
                  County:
                    ALBANY

                
	
                  Reinsurance:
                    No

                	
                  Status:
                    Mandatory

                

        

         

        

        
          	
                  Premium
                    Group

                	
                  Rate
                    Amount

                
	
                  TANF/SN
                    <6mo
                    M/F

                	
                  $262.72

                
	
                  TANF/SN
                    6mo-14 F

                	
                  $89.50

                
	
                  TANF/SN
                    15-20 F

                	
                  $130.92

                
	
                  TANF/SN
                    6m-20 M

                	
                  $87.34

                
	
                  TANF21+
                    M/F

                	
                  $212.38

                
	
                  SN
                    21-29 M/F

                	
                  $201.52

                
	
                  SN
                    30+ M/F

                	
                  $365.32

                
	
                  SSI
                    6mo-20 M/F

                	
                  $176.65

                
	
                  SSI
                    21-64 M/F

                	
                  $493.40

                
	
                  SSI
                    65+ M/F

                	
                  $438.91

                
	
                  Maternity
                    Kick Payment

                	
                  $5,097.14

                
	
                  Newborn
                    Kick Payment

                	
                  $1,734.99

                

        

         

        

         

        Optional
          Benefits Offered:

        
          	
                   

                  þ
                    Emergency Transportation

                	
                   

                   ̈
                    Dental

                
	
                   

                  þ
                    Non-Emergent Transportation

                	
                   

                  þ
Family
                    Planning

                

        

         

        Box
          will be checked if the optional benefit is covered by the
          plan

         

        

        
          
            
            

          

          
            
            

            
              

            

          

          
            
            

          

        

         

        WELLCARE
          OF NEW YORK, INC.

         

        Medicaid
          Managed Care Rates

         

        

        
          	
                  MMIS
                    ID #: 01182503 

                	
                  Effective
                    Date: 04/01/06

                
	
                  Approved
                    by DOB: Yes

                	
                  Region:
                    Central

                
	 	
                  County:
                    COLUMBIA

                
	
                  Reinsurance:
                    No 

                	
                  Status:
                    Mandatory

                

        

         

        

        
          	
                  Premium
                    Group

                	
                  Rate
                    Amount

                
	
                  TANF/SN
                    <6mo
                    M/F

                	
                  $253.60

                
	
                  TANF/SN
                    6mo-14 F

                	
                  $82.21

                
	
                  TANF/SN
                    15-20 F

                	
                  $139.77

                
	
                  TANF/SN
                    6m-20 M

                	
                  $82.59

                
	
                  TANF21+
                    M/F

                	
                  $229.28

                
	
                  SN
                    21-29 M/F

                	
                  $215.27

                
	
                  SN
                    30+ M/F

                	
                  $368.73

                
	
                  SSI
                    6mo-20 M/F

                	
                  $179.23

                
	
                  SSI
                    21-64 M/F

                	
                  $474.37

                
	
                  SSI
                    65+ M/F

                	
                  $392.42

                
	
                  Maternity
                    Kick Payment

                	
                  $5,466.64

                
	
                  Newborn
                    Kick Payment

                	
                  $1,980.01

                

        

         

        

         

        Optional
          Benefits Offered:

        
          	
                   

                  þ
                    Emergency Transportation

                	
                   

                   ̈
                    Dental

                
	
                   

                  þ
                    Non-Emergent Transportation

                	
                   

                  þ
                    Family Planning

                

        

         

        Box
          will be checked if the optional benefit is covered by the
          plan

         

        
          
            
            

          

          
            
            

            
              

            

          

          
            
            

          

        

        

        WELLCARE
          OF NEW YORK, INC.

         

        Medicaid
          Managed Care Rates

         

        

        
          	
                  MMIS
                    ID #: 01182503 

                	
                  Effective
                    Date: 04/01/06

                
	
                  Approved
                    by DOB: Yes

                	
                  Region:
                    Mid-Hudson

                
	 	
                  County:
                    DUTCHESS

                
	
                  Reinsurance:
                    No

                	
                  Status:
                    Voluntary

                

        

         

        

        
          	
                  Premium
                    Group

                	
                  Rate
                    Amount

                
	
                  TANF/SN
                    <6mo
                    M/F

                	
                  $266.87

                
	
                  TANF/SN
                    6mo-14 F

                	
                  $93.54

                
	
                  TANF/SN
                    15-20 F

                	
                  $135.68

                
	
                  TANF/SN
                    6m-20 M

                	
                  $103.07

                
	
                  TANF21+
                    M/F

                	
                  $229.75

                
	
                  SN
                    21-29 M/F

                	
                  $211.13

                
	
                  SN
                    30+ M/F

                	
                  $429.08

                
	
                  SSI
                    6mo-20 M/F

                	
                  $177.07

                
	
                  SSI
                    21-64 M/F

                	
                  $488.19

                
	
                  SSI
                    65+ M/F

                	
                  $425.44

                
	
                  Maternity
                    Kick Payment

                	
                  $5,651.55

                
	
                  Newborn
                    Kick Payment

                	
                  $2,276.59

                

        

         

        

         

        Optional
          Benefits Offered:

        
          	
                   

                  þ
                    Emergency Transportation

                	
                   

                   ̈
                    Dental

                
	
                   

                   ̈
                    Non-Emergent Transportation

                	
                   

                  þ
                    Family Planning

                

        

         

        Box
          will be checked if the optional benefit is covered by the
          plan

         

        

        
          
            
            

          

          
            
            

            
              

            

          

          
            
            

          

        

         

        WELLCARE
          OF NEW YORK, INC.

         

        Medicaid
          Managed Care Rates

         

        

        
          	
                  MMIS
                    ID #: 01182503  

                	
                  Effective
                    Date: 04/01/06 

                
	
                  Approved
                    by DOB: Yes

                	
                  Region:
                    Central

                
	 	
                  County:
                    GREENE

                
	
                  Reinsurance:
                    No

                	
                  Status:
                    Mandatory

                

        

         

        

        
          	
                  Premium
                    Group

                	
                  Rate
                    Amount

                
	
                  TANF/SN
                    <6mo
                    M/F

                	
                  $251.40

                
	
                  TANF/SN
                    6mo-14 F

                	
                  $80.40

                
	
                  TANF/SN
                    15-20 F

                	
                  $137.50

                
	
                  TANF/SN
                    6m-20 M

                	
                  $80.75

                
	
                  TANF21+
                    M/F

                	
                  $226.45

                
	
                  SN
                    21-29 M/F

                	
                  $212.51

                
	
                  SN
                    30+ M/F

                	
                  $365.67

                
	
                  SSI
                    6mo-20 M/F

                	
                  $176.18

                
	
                  SSI
                    21-64 M/F

                	
                  $470.38

                
	
                  SSI
                    65+ M/F

                	
                  $390.73

                
	
                  Maternity
                    Kick Payment

                	
                  $5,466.64

                
	
                  Newborn
                    Kick Payment

                	
                  $1,980.01

                

        

         

        

         

        Optional
          Benefits Offered:

        
          	
                   

                  þ
                    Emergency Transportation

                	
                   

                   ̈
                    Dental

                
	
                   

                   ̈
                    Non-Emergent Transportation

                	
                   

                  þ
                    Family Planning

                

        

         

        Box
          will be checked if the optional benefit is covered by the
          plan

         

        

        
          
            
            

          

          
            
            

            
              

            

          

          
            
            

          

        

         

        WELLCARE
          OF NEW YORK, INC.

         

        Medicaid
          Managed Care Rates

         

        

        
          	
                  MMIS
                    ID #: 01182503 

                	
                  Effective
                    Date: 04/01/06 

                
	
                  Approved
                    by DOB: Yes

                	
                  Region:
                    Mid-Hudson

                
	 	
                  County:
                    ORANGE

                
	
                  Reinsurance:
                    No 

                	
                  Status:
                    Voluntary

                

        

         

        

        
          	
                  Premium
                    Group

                	
                  Rate
                    Amount

                
	
                  TANF/SN
                    <6mo
                    M/F

                	
                  $263.72

                
	
                  TANF/SN
                    6mo-14 F

                	
                  $92.78

                
	
                  TANF/SN
                    15-20 F

                	
                  $132.60

                
	
                  TANF/SN
                    6m-20 M

                	
                  $102.05

                
	
                  TANF21+
                    M/F

                	
                  $226.38

                
	
                  SN
                    21-29 M/F

                	
                  $206.72

                
	
                  SN
                    30+ M/F

                	
                  $423.04

                
	
                  SSI
                    6mo-20 M/F

                	
                  $173.29

                
	
                  SSI
                    21-64 M/F

                	
                  $479.96

                
	
                  SSI
                    65+ M/F

                	
                  $420.66

                
	
                  Maternity
                    Kick Payment

                	
                  $5,651.55

                
	
                  Newborn
                    Kick Payment

                	
                  $2,276.59

                

        

         

        

         

        Optional
          Benefits Offered:

        
          	
                   

                   ̈
                    Emergency Transportation

                	
                   

                   ̈
                    Dental

                
	
                   

                   ̈
                    Non-Emergent Transportation

                	
                   

                  þ
                    Family Planning

                

        

         

        Box
          will be checked if the optional benefit is covered by the
          plan

         

         

        
          
            
            

          

          
            
            

            
              

            

          

          
            
            

          

        

        

         

        WELLCARE
          OF NEW YORK, INC.

         

        Medicaid
          Managed Care Rates

         

        

        
          	
                  MMIS
                    ID #: 01182503  

                	
                  Effective
                    Date: 04/01/06 

                
	
                  Approved
                    by DOB: Yes

                	
                  Region:
                    Northeast

                
	 	
                  County:
                    RENSSELAER

                
	
                  Reinsurance:
                    No

                	
                  Status:
                    Mandatory

                

        

         

        

        
          	
                  Premium
                    Group

                	
                  Rate
                    Amount

                
	
                  TANF/SN
                    <6mo
                    M/F

                	
                  $260.53

                
	
                  TANF/SN
                    6mo-14 F

                	
                  $87.69

                
	
                  TANF/SN
                    15-20 F

                	
                  $128.66

                
	
                  TANF/SN
                    6m-20 M

                	
                  $85.51

                
	
                  TANF21+
                    M/F

                	
                  $209.55

                
	
                  SN
                    21-29 M/F

                	
                  $198.76

                
	
                  SN
                    30+ M/F

                	
                  $362.26

                
	
                  SSI
                    6mo-20 M/F

                	
                  $173.61

                
	
                  SSI
                    21-64 M/F

                	
                  $489.42

                
	
                  SSI
                    65+ M/F

                	
                  $437.22

                
	
                  Maternity
                    Kick Payment

                	
                  $5,097.14

                
	
                  Newborn
                    Kick Payment

                	
                  $1,734.99

                

        

         

        

         

        Optional
          Benefits Offered:

        
          	
                   

                  þ
                    Emergency Transportation

                	
                   

                   ̈
                    Dental

                
	
                   

                   ̈
                    Non-Emergent Transportation

                	
                   

                  þ
                    Family Planning

                

        

         

        Box
          will be checked if the optional benefit is covered by the
          plan

         

        

         

        
          
            
            

          

          
            
            

            
              

            

          

          
            
            

          

        

         

         

        WELLCARE
          OF NEW YORK, INC.

         

        Medicaid
          Managed Care Rates

         

        
          	
                  MMIS
                    ID #: 01182503 

                	
                  Effective
                    Date: 04/01/06 

                
	
                  Approved
                    by DOB: Yes

                	
                  Region:
                    Northern Metro

                
	 	
                  County:
                    ROCKLAND

                
	
                  Reinsurance:
                    No

                	
                  Status:
                    Mandatory

                

        

         

        
          	
                  Premium
                    Group

                	
                  Rate
                    Amount

                
	
                  TANF/SN
                    <6mo
                    M/F

                	
                  $247.24

                
	
                  TANF/SN
                    6mo-14 F

                	
                  $87.55

                
	
                  TANF/SN
                    15-20 F

                	
                  $111.50

                
	
                  TANF/SN
                    6m-20 M

                	
                  $97.90

                
	
                  TANF21+
                    M/F

                	
                  $190.15

                
	
                  SN
                    21-29 M/F

                	
                  $262.49

                
	
                  SN
                    30+ M/F

                	
                  $413.23

                
	
                  SSI
                    6mo-20 M/F

                	
                  $176.29

                
	
                  SSI
                    21-64 M/F

                	
                  $548.38

                
	
                  SSI
                    65+ M/F

                	
                  $413.23

                
	
                  Maternity
                    Kick Payment

                	
                  $4,812.65

                
	
                  Newborn
                    Kick Payment

                	
                  $1,569.65

                

        

         

        

         

        Optional
          Benefits Offered:

        
          	
                   

                  þ
                    Emergency Transportation

                	
                   

                   ̈
                    Dental

                
	
                   

                   ̈
                    Non-Emergent Transportation

                	
                   

                  þ
                    Family Planning

                

        

         

        Box
          will be checked if the optional benefit is covered by the
          plan

         

        

         

        
          
            
            

          

          
            
            

            
              

            

          

          
            
            

          

        

        

         

        WELLCARE
          OF NEW YORK, INC.

         

        Medicaid
          Managed Care Rates

         

        

        
          	
                  MMIS
                    ID #: 01182503 

                	
                  Effective
                    Date: 04/01/06 

                
	
                  Approved
                    by DOB: Yes

                	
                  Region:
                    Mid-Hudson

                
	 	
                  County:
                    SULLIVAN

                
	
                  Reinsurance:
                    No

                	
                  Status:
                    Voluntary

                

        

         

        

        
          	
                  Premium
                    Group

                	
                  Rate
                    Amount

                
	
                  TANF/SN
                    <6mo
                    M/F

                	
                  $263.72

                
	
                  TANF/SN
                    6mo-14 F

                	
                  $92.78

                
	
                  TANF/SN
                    15-20 F

                	
                  $132.60

                
	
                  TANF/SN
                    6m-20 M

                	
                  $102.05

                
	
                  TANF21+
                    M/F

                	
                  $226.38

                
	
                  SN
                    21-29 M/F

                	
                  $206.72

                
	
                  SN
                    30+ M/F

                	
                  $423.04

                
	
                  SSI
                    6mo-20 M/F

                	
                  $173.29

                
	
                  SSI
                    21-64 M/F

                	
                  $479.96

                
	
                  SSI
                    65+ M/F

                	
                  $420.66

                
	
                  Maternity
                    Kick Payment

                	
                  $5,615.55

                
	
                  Newborn
                    Kick Payment

                	
                  $2,276.59

                

        

         

        

         

        Optional
          Benefits Offered:

        
          	
                   

                   ̈
                    Emergency Transportation

                	
                   

                   ̈
                    Dental

                
	
                   

                   ̈
                    Non-Emergent Transportation

                	
                   

                  þ
                    Family Planning

                

        

         

        Box
          will be checked if the optional benefit is covered by the
          plan

         

         

        
          
            
            

          

          
            
            

            
              

            

          

          
            
            

          

        

        

         

        WELLCARE
          OF NEW YORK, INC.

         

        Medicaid
          Managed Care Rates

         

        

        
          	
                  MMIS
                    ID #: 01182503 

                	
                  Effective
                    Date: 04/01/06

                
	
                  Approved
                    by DOB: Yes

                	
                  Region:
                    Mid-Hudson

                
	 	
                  County:
                    ULSTER

                
	
                  Reinsurance:
                    No

                	
                  Status:
                    Voluntary

                

        

         

        

        
          	
                  Premium
                    Group

                	
                  Rate
                    Amount

                
	
                  TANF/SN
                    <6mo
                    M/F

                	
                  $263.72

                
	
                  TANF/SN
                    6mo-14 F

                	
                  $92.78

                
	
                  TANF/SN
                    15-20 F

                	
                  $132.60

                
	
                  TANF/SN
                    6m-20 M

                	
                  $102.05

                
	
                  TANF21+
                    M/F

                	
                  $226.38

                
	
                  SN
                    21-29 M/F

                	
                  $206.72

                
	
                  SN
                    30+ M/F

                	
                  $423.04

                
	
                  SSI
                    6mo-20 M/F

                	
                  $173.29

                
	
                  SSI
                    21-64 M/F

                	
                  $479.96

                
	
                  SSI
                    65+ M/F

                	
                  $420.66

                
	
                  Maternity
                    Kick Payment

                	
                  $5,615.55

                
	
                  Newborn
                    Kick Payment

                	
                  $2,276.59

                

        

         

        

         

        Optional
          Benefits Offered:

        
          	
                   

                   ̈
                    Emergency Transportation

                	
                   

                   ̈
                    Dental

                
	
                   

                   ̈
                    Non-Emergent Transportation

                	
                   

                  þ
                    Family Planning

                

        

         

        Box
          will be checked if the optional benefit is covered by the
          plan

         

        

        
          
            
            

          

          
            
            

            
              

            

          

          
            
            

          

        

        WELLCARE
          OF NEW YORK, INC.

         

        Family
          Health Plus Rates

         

        Effective
          April 1, 2006

         

        
          	
                   

                	
                   

                	
                   

                	
                   

                	
                  Optional

                  Benefits
                    covered

                
	
                  County  

                	
                  Adults
                    with Children 19 -64

                	
                  Adults
                    without Children 19 - 29

                	
                  Adults
                    without Children 30 - 64

                	
                  Maternity
                    Kick

                	
                  Family

                  Planning

                	
                  Dental

                
	
                  ALBANY

                	
                  $253.35

                	
                  $250.47

                	
                  $510.54

                	
                  $5,097.14

                	
                  Yes

                	
                  Yes

                
	
                  COLUMBIA

                	
                  $270.53

                	
                  $258.71

                	
                  $498.03

                	
                  $5,466.64

                	
                  Yes

                	
                  Yes

                
	
                  DUTCHESS 

                	
                  $260.42

                	
                  $291.38

                	
                  $528.18

                	
                  $5,651.55

                	
                  Yes

                	
                  Yes

                
	
                  GREENE

                	
                  $270.53

                	
                  $258.71

                	
                  $498.03

                	
                  $5,466.64

                	
                  Yes

                	
                  Yes

                
	
                  ORANGE

                	
                  $260.42

                	
                  $291.38

                	
                  $528.18

                	
                  $5,651.55

                	
                  Yes

                	
                  Yes

                
	
                  RENSSELAER

                	
                  $253.35

                	
                  $250.47

                	
                  $510.54

                	
                  $5,097.14

                	
                  Yes

                	
                  Yes

                
	
                  ROCKLAND

                	
                  $256.16

                	
                  $208.81

                	
                  $471.77

                	
                  $4,812.65

                	
                  Yes

                	
                  Yes

                
	
                  ULSTER

                	
                  $260.42

                	
                  $291.38

                	
                  $528.18

                	
                  $5,651.55

                	
                  Yes

                	
                  Yes

                
	
                  NEW
                    YORK

                	
                  $196.82

                	
                  $151.39

                	
                  $245.60

                	
                  $5,114.41

                	
                  Yes

                	
                  Yes

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00109-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00109-of-00352.parquet"}]]