WellCare of New York, Inc

EX-10.13 14 h3361benefitattestation.htm H3361 BENEFIT ATTESTATION h3361benefitattestation.htm
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Exhibit 10.13
 


Medicare Advantage Attestation of Benefit Plan
 
WELLCARE_OF NEW YORK, INC.
 
H3361
 
Date: 08/29/2012
 
I attest that I have examined the Plan Benefit Packages (PBPs) identified below and that the benefits identified in the PBPs are those that the above­stated organization will make available to eligible beneficiaries in the approved service area during program year 2013. I further attest that we have reviewed the bid pricing tools (BPTs) with the certifying actuary and have determined them to be consistent with the PBPs being attested to here.
 
I further attest that these benefits will be offered in accordance with all applicable Medicare program authorizing statutes and regulations and program guidance that CMS has issued to date and will issue during the remainder of 2012 and 2013, including but not limited to, the 2013 Call Letter, the 2013 Solicitations for New Contract Applicants, the Medicare Prescription Drug Benefit Manual, the Medicare Managed Care Manual, and the CMS memoranda issued through the Health Plan Management System (HPMS).
 
Plan
ID
Segment
ID
Version
Plan Name
Plan
Type
Transaction
Type
MA
Premium
Part D
Premium
CMS Approval
Date
Effective
Date
043
0
6
WellCare Liberty (HMO SNP)
HMO
Renewal
0.00
20.60
08/20/2012
01/01/2013
059
0
5
WellCare Advance (HMO)
HMO
Renewal
0.00
N/A
08/20/2012
01/01/2013
065
0
7
WellCare Access (HMO SNP)
HMO
Renewal
0.00
18.90
08/20/2012
01/01/2013
098
0
6
WellCare Liberty (HMO SNP)
HMO
Renewal
0.00
16.90
08/20/2012
01/01/2013
099
0
8
WellCare Value (HMO- POS)
HMOPOS
Renewal
0.00
0.00
08/24/2012
01/01/2013
105
0
6
WellCare Advocate Complete (HMO SNP)
HMO
Renewal
0.00
28.40
08/20/2012
01/01/2013
106
0
6
WellCare Choice (HMO- POS)
HMOPOS
Renewal
0.00
0.00
08/20/2012
01/01/2013
109
0
6
WellCare Access (HMO SNP)
HMO
Renewal
0.00
40.40
08/20/2012
01/01/2013
129
0
6
WellCare Choice (HMO- POS)
HMOPOS
Renewal
0.00
0.00
08/20/2012
01/01/2013
130
0
6
WellCare Rx (HMO)
HMO
Renewal
0.00
1.60
08/20/2012
01/01/2013
 
 
 

H3361

 
 

 



 
 THOMAS TRAN    8/29/2012 2:07:21 PM  
        
 Contracting Official Name    Date  
       
       
       
     P.O. BOX 1652  
 WELLCARE_OF NEW YORK, INC.    NEWBURGH, NY 12551  
       
 Organization    Address  
 
 
 
 
 
 
H3361