Document:

exhibit10-1.htm

    
      
Back
      to
      Form 8-K

    Exhibit
      10.1

     

    

      
        ATTACHMENT
          I 

        RATE
          SHEETS

         

      

      
        	
                (a)

              	
                Contractor
                  Name:

              	
                Harmony
                  Health Plan of Illinois, Inc.

                 

              
	 	
                Address:

              	
                
                  200
                    West Adams Street

                

                
                  Chicago,
                    IL 60606

                

                
                   

                

              
	
                (b)

              	
                
                  Contracting
                    Arca(s) Covered by the Contractor and Enrollment
                    Limit:

                

              

      

      
        

      

      
         

      

      
        	
                
                  Contracting
                    Area

                

              	
                
                  Enrollment
                    Limit

                

              
	
                
                  Region
                    III - St. Clair, Madison, Perry,

                

                
                  Randolph,
                    and Washington Counties

                

                
                  Jackson
                    County (9/1/07)

                

                
                  Williamson
                    County (9/1/07)

                

              	
                
                  50,000

                

              
	
                
                  Region
                    IV

                

              	
                
                  200,000

                

              
	 	 

      

      
         

      

      
        (c)      Total
          Enrollment Limit for all Contracting
          Areas:    250,000

      

      
        

      

      
        (e)       Standard
          Capitation Rates for Enrollees, effective August 1, 2006 through July 31,
          2008:*

      

      
        

      

      

      
        	
                
                  Age/Gender

                

                
                  Mo
                    = month

                

                
                  Yr
                    = year

                

              	
                
                  Region
                    I

                

                
                  (N-W,
                    Illinois) 

                  PMPM

                

              	
                
                  Region
                    II 

                  (Central
                    Illinois) 

                  PMPM

                

              	
                
                  Region
                    III

                

                
                  (Southern
                    Illinois)

                

                
                  PMPM

                

              	
                
                  Region
                    IV

                

                
                  (Cook
                    County)

                

                
                  PMPM

                

              	
                
                  Region
                    V 

                  (Collar
                    Counties)
                    

                  PMPM

                

              
	
                
                  0-3Mo

                

              	
                
                  $1,290.99

                

              	
                
                  $1
                    047.86

                

              	
                
                  $1,214.79

                

              	
                
                  $1,383.98

                

              	
                
                  $1,008.88

                

              
	
                
                  4Mo-lYr

                

              	
                
                  $122,07

                

              	
                
                  $124.58

                

              	
                
                  $147.56

                

              	
                
                  $139.60

                

              	
                
                  $131.27

                

              
	
                
                  2Yr-5Yr

                

              	
                
                  $51.37

                

              	
                
                  $55.46

                

              	
                
                  $64.68

                

              	
                
                  $59.00

                

              	
                
                  $49.44

                

              
	
                
                  6Yr-13Yr

                

              	
                
                  $43.52

                

              	
                
                  $50.34

                

              	
                
                  $55.12

                

              	
                
                  $43.63

                

              	
                
                  $40.03

                

              
	
                
                  14Yr-20Yr,
                    Male

                

              	
                
                  $75.31

                

              	
                
                  $83.05

                

              	
                
                  $78.87

                

              	
                
                  $64.90

                

              	
                
                  $82.39

                

              
	
                
                  14Yr-20Y,
                    Female

                

              	
                
                  $117.55

                

              	
                
                  $118.15

                

              	
                
                  $136.31

                

              	
                
                  $100.33

                

              	
                
                  $98.16

                

              
	
                
                  21Yr-44Yr,Male

                

              	
                
                  $114.27

                

              	
                
                  $136.04

                

              	
                
                  $123.73

                

              	
                
                  $127.39

                

              	
                
                  $166.05

                

              
	
                
                  2
                    lYr-44Yr, Female

                

              	
                
                  $157.98

                

              	
                
                  $157.44

                

              	
                
                  $166.17

                

              	
                
                  $149.48

                

              	
                
                  $151.36

                

              
	
                
                  45Yrf
                    Male and Female

                

              	
                
                  $227.11

                

              	
                
                  $255.07

                

              	
                
                  $256.05

                

              	
                
                  $239.45

                

              	
                
                  $253.90

                

              

      

      
         

        *
          Capitation rates listed are 100% of actuarially certified rates, but only
          99.5%
          will be paid in year one of the Contract and 99% in year two of the Contract
          in
          accordance with Section 7.8.

      

      
        

        (f)       Hospital
          Delivery Case Rate, effective August 1, 2006 through July 31, 2008:

        
 

        
          
            	
                    
                      Hospital
                        Delivery Case Rate
                        (per
                        delivery)

                    

                  	
                    
                      $3,501.90

                    

                  	
                    
                      $3,424.73

                    

                  	
                    
                      $3,591.08

                    

                  	
                    
                      $3,977.36

                    

                  	
                    
                      $3,645.96exhibit10-2.htm

    
      
        

      

    

    Back
      to
      Form 8-K

    Exhibit
      10.2

    
 

    
      
        	
                APPENDIX
                  X

                 

              
	
                Agency
                  Code: 12000

              	
                Contract
                  No. C-014386

              
	
                Period:
                  October 1, 1997 – December 31, 2007

              	
                Funding
                  Amount for Period: No Change

              

      

      

      This
        is
        an AGREEMENT between THE STATE OF NEW YORK, acting by and through the Department
        of Health, having its principal office at Corning Tower, Empire State Plaza,
        Albany NY (hereinafter referred to as the STATE) and WellCare of New
        York, Inc. herein after referred to as the CONTRACTOR), for
        modification of Contract Number C-014386 as reflected in the attached revisions
        to Section I.B.1. of the Agreement and Appendices A-2, E, H, and L and to
        extend
        the period of the contract through December 31, 2007.

      

      The
        CONTRACTOR acknowledges that the STATE is currently developing a replacement
        contract to govern services provided to Child Health Plus enrollees. This
        CONTRACT No. C-014386 will be cancelled and its terms deemed null and void
        upon
        effective date of replacement contract.

      

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

      

      IN
        WITHESS 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/  Judith Arnold   

              
	
                Title:
                  President & CEO

              	
                Title:
                  Director

                Division
                  of Coverage and Enrollment

                Office
                  of Health Insurance Programs

                 

              
	
                Date:
                  6/21/2007

              	
                Date:
                  7/12/2007

              
	 	
                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

      County
        of
        Hillsborough

      

      On
        the
        21st day of
        June, 2007, before me personally appeared Todd Farha, to me known, who being
        duly sworn, did depose and say that he/she resides at Tampa, FL, that he
        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
        name
        thereto by order of the board of directors of said corporation.

      

      Notary

      
        
           

        

        
           

          
            

          

        

        
           

        

      

      STATE
        OF NEW YORK AGREEMENT

      

      Section
        1.B.1 is revised to read as follows:

      

      I.  Conditions
        of Agreement

      

      B.1.
        This
        AGREEMENT is extended through December 31, 2007.

      
        
           

        

        
           

          
            

          

        

        
           

        

      

      APPEDIX
        A-2

      PROGRAM
        SPECIFIC CLAUSES

      

      Effective
        9/1/07 , Section III.H.2 revised to read as follows:

      

      H.
        Presumptive and Temporary Enrollment:

      

      2.
        A
        child enrolled in Child Health Plus who screens as Medicaid eligible upon
        recertification in Child Health Plus may continue to be enrolled temporarily
        in
        Child Health Plus until a Medicaid determination is made, provided all required
        documentation is collected and the Medicaid Application has been submitted
        to
        the appropriate LDSS.

      

      The
        temporary enrollment period shall continue until the earlier of the date
        a
        Medicaid or Child Health Plus eligibility determination is made or two (2)
        months after the date temporary enrollment begins. If a child is determined
        to
        be ineligible for Medicaid prior to the last day of the two (2) month temporary
        enrollment period, such child may continue to be presumptively enrolled in
        Child
        Health Plus as described in subparagraph one above until the earlier of the
        date
        a Child Health Plus eligibility determination is made or the last day of
        the two
        (2) month presumptive eligibility period. Temporary enrollment shall only
        be
        granted to an enrollee once in a twelve month period. A temporary enrollment
        period may be extended in the event a Medicaid eligibility determination
        is not
        made within the two (2) month period through no fault of the applicant, as
        long
        as the required documentation has been submitted within the two (2) month
        period. Subsequent to the two (2) month period, it is the responsibility
        of the
        CONTRACTOR or facilitator, depending on with whom the family applied, to
        follow
        up on the status of the applicant’s Medicaid application with the appropriate
        LDSS office on a monthly basis, commencing on or about the 120th day following
        the
        completion of the Child Health Plus application. If the child is determined
        to
        be ineligible for Medicaid, the CONTRACTOR shall collect documentation of
        such
        denial from the applicable LDSS. In no case will the temporary enrollment
        period
        be extended beyond a twelve-month period.

      

      Effective
        9/1/07, contingent upon receipt of federal approval to implement the income
        expansion, Section III is revised by adding a new paragraph O to read as
        follows:

      

      O.
        Waiting Period:

      

      The
        CONTRACTOR shall determine if a child eligible for subsidized coverage whose
        household income is between 251 and 400 percent of the federal poverty level
        was
        covered by a group health plan based upon a family member’s employment during
        the six month period prior to the date of application.  A child who
        was covered by a group health plan is not eligible for CHPlus until after
        a six
        month waiting period, unless the child meets one of the following
        exceptions:

       

      
        	
                1.
                  

              	
                Loss
                  of employment due to factors other than voluntary
                  separation;

              

      

      
        	
                2.
                  

              	
                Death
                  of the family member which results in termination of coverage under
                  a
                  group health plan under which the child is
                  covered;

              

      

      
        
           

        

        
           

          
            

          

        

        
           

        

      

      
        	
                3.
                  

              	
                Chang
                  to a new employer that does not provide an option for comprehensive
                  health
                  benefits coverage;

              

      

      
        	
                4.

              	
                 Change
                  of residence so that no employer-based comprehensive health benefits
                  coverage is available

              

      

      
        	
                5.
                  

              	
                Discontinuation
                  of comprehensive health benefits coverage to all employees of the
                  applicant’s employer;

              

      

      
        	
                6.
                  

              	
                Expiration
                  of the coverage periods established by COBRA or the provisions
                  of
                  subsection (m) of section three thousand two hundred twenty-one,
                  subsection (k) of section four thousand three hundred four and
                  subsection
                  (e) of section four thousand three hundred five of the insurance
                  law;

              

      

      
        	
                7.
                  

              	
                Termination
                  of comprehensive health benefits coverage due to long term
                  disability;

              

      

      
        	
                8.
                  

              	
                Cost
                  of employment-based health insurance is more than five percent
                  of the
                  family’s income;

              

      

      
        	
                9.
                  

              	
                A
                  Child applying for coverage under this title is pregnant;
                  or

              

      

      
        	
                10.
                  

              	
                A
                  child applying for coverage under this title is at or below the
                  age of
                  five or an age approved by the federal government and specified
                  by the
                  STATE in administrative guidance.  The
                  age of children falling under this exception is contingent upon
                  receipt of
                  federal approval.

              

      

      
        	
                 

              	
                 

              

      

      

      The
        CONTRACTOR shall implement the waiting period described above in accordance
        with
        administrative guidance provided by the STATE.

      
        
           

        

        
           

          
            

          

        

        
           

        

      

      
        	
                 

              	
                APPENDIX
                  E

              

      

      
        	
                 

              	
                Financial
                  Information

              

      

      

      
        	
                 

              	
                Section
                  A is revised to read as follows:

              

      

      

      
        	
                A.

              	
                WellCare
                  of New York, Inc. shall receive, for the period July, 1 2007 through
                  December 31, 2007, an amount up to, but not to exceed, $8,490,000
                  to
                  provide and administer a Child Health Plus program for uninsured
                  children
                  in the counties identified in Appendix A-2, Section II.B.1 of this
                  AGREEMENT or as modified by the STATE. Payment of this amount if
                  based on
                  the CONTRACTOR meeting the responsibilities provided in this
                  AGREEEMENT.

              

      

      

      
        	
                 

              	
                Additional
                  Premium Information:

              

      

      

      
        	
                 

              	
                For
                  Bronx, Kings, New York and Queens
                  county(ies):

              

      

      

      The
        total
        monthly premium shall be: $118.37

      

      The
        State
        share of the total premium shall be $118.37 or the total monthly premium
        for
        children in families with gross household income less than 160% of the federal
        poverty level and children who are American Indians or Alaskan Natives
        (AI/AN).

      

      The
        State
        share of the total monthly premium shall be $109.37 or the total monthly
        premium
        minus $9 for children in families with gross household income between 160%
        and
        222% of the federal poverty level with a maximum of $27 per month per family.
        The State share is the total monthly premium less $9 for each of the first
        three
        children. For additional children, the State share is the total monthly
        premium.

      

      The
        State
        share of the total monthly premium shall be $103.37 or the total monthly
        premium
        minus $15 for children in families with gross household income between 223%
        and
        250% of the federal poverty level with a maximum of $45 per month per family.
        The State share is the total premium less $15 for each of the first three
        children. For additional children the State share is the total monthly
        premium.

      

      Effective
        9/1/07, contingent upon receipt of federal approval to implement the income
        expansion, the following subsidy categories are added:

      

      The
        state
        share of the total monthly premium shall be $98.37 of the total monthly premiums
        minus $20 for children in families with gross household income between 251%
        and
        300% of the federal poverty level with a maximum of $60 per month per family.
        The State share is the total monthly premium less $20 for each of the first
        three children. For additional children, the State share is the total monthly
        premium.

      

      The
        State
        share of the total monthly premium shall be $88.37 or the total monthly premium
        minus $30 for children in families with gross household income between 301%
        and
        350% of the federal poverty level with a maximum of $90 per month per family.
        The State share is the total monthly premium less $30 for each of the first
        three children. For additional children, the State share is the total monthly
        premium.

      

      The
        State
        share of the total monthly premium shall be $78.37 or the total monthly premium
        minus $40 for children in families with gross household income between 351%
        and
        400% of the federal poverty level with a maximum of $120 per month per
        family.  The State share is the total monthly

      
        
           

        

        
           

          
            

          

        

        
           

        

      

      premium
        less $40 for each of the first three children. For additional children, the
        State share is the total monthly premium.

      

      For
        Dutchess, Orange, Rockland and Ulster county(ies):

      

      The
        total
        monthly premium shall be: $106.67

      

      The
        state
        share of the total monthly premium shall be $106.67 of the total monthly
        premiums for children in families with gross household income less than 160%
        of
        the federal poverty level and children who are American Indians or Alaskan
        Natives (AI/AN).

      

      The
        state
        share of the total monthly premium shall be $97.67 of the total monthly premiums
        minus $9 for children in families with gross household income between 160%
        and
        222% of the federal poverty level with a maximum of $27 per month per family.
        The State share is the total monthly premium less $9 for each of the first
        three
        children. For additional children, the State share is the total monthly
        premium.

      

      The
        state
        share of the total monthly premium shall be $91.67 of the total monthly premiums
        minus $15 for children in families with gross household income between 223%
        and
        250% of the federal poverty level with a maximum of $45 per month per family.
        The State share is the total monthly premium less $15 for each of the first
        three children. For additional children, the State share is the total monthly
        premium.

      

      Effective
        9/1/07, contingent upon receipt of federal approval to implement the income
        expansion, the following subsidy categories are added:

      

      The
        state
        share of the total monthly premium shall be $86.67 of the total monthly premiums
        minus $20 for children in families with gross household income between 251%
        and
        300% of the federal poverty level with a maximum of $60 per month per family.
        The State share is the total monthly premium less $20 for each of the first
        three children. For additional children, the State share is the total monthly
        premium.

      

      The
        State
        share of the total monthly premium shall be $76.67 or the total monthly premium
        minus $30 for children in families with gross household income between 301%
        and
        350% of the federal poverty level with a maximum of $90 per month per family.
        The State share is the total monthly premium less $30 for each of the first
        three children. For additional children, the State share is the total monthly
        premium.

      

      The
        State
        share of the total monthly premium shall be $66.67 or the total monthly premium
        minus $40 for children in families with gross household income between 351%
        and
        400% of the federal poverty level with a maximum of $120 per month per
        family.  The State share is the total monthly premium less $40 for
        each of the first three children. For additional children, the State share
        is
        the total monthly premium.

      

      For
        Albany, Columbia, Greene, Rensselaer county(ies):

      

      The
        total
        monthly premium shall be: $105.68

      

      The
        state
        share of the total monthly premium shall be $105.68 of the total monthly
        premiums for children in families with gross household income less than 160%
        of
        the federal poverty level and children who are American Indians or Alaskan
        Natives (AI/AN).

      
        
           

        

        
           

          
            

          

        

        
           

        

      

      

      The
        state
        share of the total monthly premium shall be $96.68 of the total monthly premiums
        minus $9 for children in families with gross household income between 160%
        and
        222% of the federal poverty level with a maximum of $27 per month per family.
        The State share is the total monthly premium less $9 for each of the first
        three
        children. For additional children, the State share is the total monthly
        premium.

      

      The
        state
        share of the total monthly premium shall be $90.68 of the total monthly premiums
        minus $15 for children in families with gross household income between 223%
        and
        250% of the federal poverty level with a maximum of $45 per month per family.
        The State share is the total monthly premium less $15 for each of the first
        three children. For additional children, the State share is the total monthly
        premium.

      

      Effective
        9/1/07, contingent upon receipt of federal approval to implement the income
        expansion, the following subsidy categories are added:

      

      The
        state
        share of the total monthly premium shall be $85.68 of the total monthly premiums
        minus $20 for children in families with gross household income between 251%
        and
        300% of the federal poverty level with a maximum of $60 per month per family.
        The State share is the total monthly premium less $20 for each of the first
        three children. For additional children, the State share is the total monthly
        premium.

      

      The
        State
        share of the total monthly premium shall be $75.68 or the total monthly premium
        minus $30 for children in families with gross household income between 301%
        and
        350% of the federal poverty level with a maximum of $90 per month per family.
        The State share is the total monthly premium less $30 for each of the first
        three children. For additional children, the State share is the total monthly
        premium.

      

      The
        State
        share of the total monthly premium shall be $65.68 or the total monthly premium
        minus $40 for children in families with gross household income between 351%
        and
        400% of the federal poverty level with a maximum of $120 per month per
        family.  The State share is the total monthly premium less $40 for
        each of the first three children. For additional children, the State share
        is
        the total monthly premium.

      

      In
        the
        absence of an approved premium modification by the Department of Health and
        State Insurance Department, the premium above or subsequent premium approved
        (whichever is in effect) shall continue as the State’s subsidy through December
        31, 2007.

      
        
           

        

        
           

          
            

          

        

        
           

        

      

      APPENDIX
        H

      Additional
        Program Specific Clauses

      

      Effective
        9/1/07, Section C, paragraph 2 is revised to read as follows:

      

      C.      Other
        Health Insurance Crowd Out

      

      ·  If
        the
        STATE determines that crowd-out of occurring in excess of a percentage specified
        in the State Child Health Plan established under title XXI of the federal
        Social
        Security Act or as may be specified by the Secretary of the federal Department
        of Health and Human Services, the following eligibility criterion must be
        implemented:

      

      ·  The
        child
        must not have been covered by a group health plan based upon a family member’s
        employment during the six (6) moth period prior to the date of application
        unless one of the following exceptions applies:

      

      
        	
                -  

              	
                Loss
                  of employment due to factors other than voluntary
                  separation;

              

      

      
        	
                -  

              	
                Death
                  of the family member which results in termination of coverage under
                  a
                  group health plan under which the child is
                  enrolled;

              

      

      
        	
                -  

              	
                Change
                  to a new employer that does not provide an option for comprehensive
                  health
                  benefits coverage;

              

      

      
        	
                -  

              	
                Change
                  of residence so that no employer-based comprehensive health benefits
                  coverage is available;

              

      

      
        	
                -  

              	
                Discontinuation
                  of comprehensive health benefits coverage to all employees of the
                  applicant’s employer;

              

      

      
        	
                -  

              	
                Expiration
                  of the coverage periods established by COBRA or the provisions
                  of section
                  3221(m), 4304 (k) and 4305(e) of the Insurance
                  Law;

              

      

      
        	
                -  

              	
                Termination
                  of comprehensive health benefits coverage due to long-term
                  disability;

              

      

      
        	
                -  

              	
                Cost
                  of employment-based health insurance is more than five percent
                  of the
                  family’s income;

              

      

      
        	
                -  

              	
                Child
                  applying for coverage under this title is pregnant’
                  or

              

      

      
        	
                -  

              	
                Child
                  applying for coverage under this title is at or below the age of
                  five or
                  an age approved by the federal government and specified by the
                  STATE in
                  administrative guidance. The age of children falling under this
                  exception
                  is contingent upon receipt of federal
                  approval.

              

      

      
        
           

        

        
           

          
            

          

        

        
           

        

      

    

     

    

      APPENDIX
        L

      Privacy
        and Confidentiality

      

      

      Section
        II is revised as follows:

      

      II.
        Effective April 14, 2003, the CONTRACTOR shall comply with the following
        agreement:

      

      Federal
        health Insurance Portability and Accountability Act (HIPAA)

      Business
        Associate Agreement (“Agreement”)

      

      This
        Business Associate Agreement between the New York State Department of Health
        and
        WellCare of New York, Inc. hereinafter referred to as the Business Associate,
        is
        effective on April 14, 2003 to December 31, 2007.

Source: [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00129-of-00352.parquet"}, [{"source": "alea-institute/alea-institute/kl3m-data-edgar-agreements/train-00129-of-00352.parquet"}]]