2012 Benefit Attestation to Contract H1216 between the Centers for Medicare & Medicaid Services and Harmony Health Plan of Illinois, Inc. dba Harmony Health Plan of Missouri

EX-10.8 9 attestationh1216.htm 2012 BENEFIT ATTESTATION TO CONTRACT H1216 attestationh1216.htm
Back to Form 8-K
Medicare Advantage Attestation of Benefit Plan
 
HARMONY HEALTH PLAN OF ILLINOIS, INC.
 
H1216

I attest that I have examined the Plan Benefit Packages (PBPs) identified below and that the benefits identified in the PBPs are those that the above-stated organization will make available to eligible beneficiaries in the approved service area during program year 2012. I further attest that we have reviewed the bid pricing tools (BPTs) with the certifying actuary and have determined them to be consistent with the PBPs being attested to here.

I further attest that these benefits will be offered in accordance with all applicable Medicare program authorizing statutes and regulations and program guidance that CMS has issued to date and will issue during the remainder of 2011 and 2012, including but not limited to, the 2012 Call Letter, the 2012 Solicitations for New Contract Applicants, the Medicare Prescription Drug Benefit Manual, the Medicare Managed Care Manual, and the CMS memoranda issued through the Health Plan Management System (HPMS).
 
Plan
ID
Segment
ID
Version
Plan Name
Plan
Type
Transaction
Type
MA
Premium
Part D
Premium
CMS Approval
Date
Effective
Date
001
0
7
WellCare Value (HMO-
POS)
HMOPOS
Renewal
0.00
0.00
09/02/11
01/01/12
003
0
8
WellCare Access
(HMO SNP)
HMO
Renewal
0.00
28.10
09/02/11
01/01/12
 
 
 
 
       H1216
                                                                         

 
 
 
 
 
 
THOMAS TRAN
 
    9/1/2011 10:45:27 AM  
 
Contracting Official Name 
    Date  
 
 
 
 
HARMONY HEALTH PLAN OF ILLINOIS, INC.
 
  
23 Public Square
Suite 400
Belleville, IL 62220
 
  
 
Organization 
  
 
Address
  
                    
 
 
 
 
                                                        
       H1216