Medicare Advantage Benefit Attestation Agreement between WellCare of Texas, Inc. and CMS for Plan H1264 (2011)
Summary
WellCare of Texas, Inc. attests that the listed Medicare Advantage plans and their benefits will be offered to eligible beneficiaries in the approved service area for the 2011 program year. The company confirms that the plan benefits and pricing are accurate and comply with all applicable Medicare statutes, regulations, and guidance from the Centers for Medicare & Medicaid Services (CMS). The attestation is signed by a contracting official and includes plan details, effective dates, and compliance commitments.
EX-10.9 10 attestationh1264.htm BENEFIT ATTESTATION FOR CONTRACT H1264 attestationh1264.htm
H1264
Back to Form 8-K
Exhibit 10.9
Medicare Advantage Attestation of Benefit Plan
WELLCARE OF TEXAS, INC.
H1264
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 |
| 004 | 0 | 5 | WellCare Value (HMO -POS) | HMOPOS | Renewal | 0.00 | 0.00 | 09/03/2010 | 1/1/2011 |
| 007 | 0 | 5 | WellCare Access (HMO SNP) | HMO | Renewal | 0.00 | 28.20 | 09/03/2010 | 1/1/2011 |
| 008 | 0 | 6 | WellCare Dividend (HMO) | HMO | Renewal | 0.00 | 0.00 | 09/03/2010 | 01/01/2011 |
| 014 | 0 | 6 | WellCare Dividend (HMO) | HMO | Renewal | 0.00 | 0.00 | 09/03/2010 | 1/1/2011 |
H1264
| Thomas Tran | 9/2/2010 7:56:42 AM | ||
| Contracting Official Name | Date | ||
| WELLCARE OF TEXAS, INC. | 8735 Henderson Rd | ||
| Ren 1 | |||
| Tampa, FL 33634 | |||
| Organization | Address | ||
H1264
