2011 Benefit Attestation to Contract H0913 between the Centers for Medicare & Medicaid Services and WellCare Health Insurance Plans of New Jersey, Inc

EX-10.5 6 attestationh0913.htm BENEFIT ATTESTATION FOR CONTRACT H0913 attestationh0913.htm
Back to Form 8-K
Exhibit 10.5
 
Medicare Advantage Attestation of Benefit Plan
 
WELLCARE HEALTH PLANS OF NEW JERSEY, INC.
 
H0913
 
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 2011. 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 2010 and 2011, including but not limited to, the 2011 Call Letter, the 2011 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
002
0
5
WellCare Value (HMO)
HMO
Renewal
0.00
0.00
09/03/2010
01/01/2011
003
0
6
WellCare Access (HMO
SNP)
HMO
Renewal
0.00
35.70
09/03/2010
01/01/2011
 
H0913
 
 
 

 

Thomas Tran
 
9/2/2010 7:55:00AM
       
     
Contracting Official Name
Date
     
     
     
WELLCARE HEALTH PLANS OF NEW JERSEY, INC.
P.O.Box 26011
   
Tampa, FL  ###-###-####
       
       
Organization
Address
     

H0913