2011 Benefit Attestation to Contract H2491 between the Centers for Medicare & Medicaid Services and WellCare Health Insurance of Arizona, Inc
EX-10.13 14 attestationh2491.htm BENEFIT ATTESTATION FOR CONTRACT H2491 attestationh2491.htm
Back to Form 8-K
Exhibit 10.13
Medicare Advantage Attestation of Benefit Plan
WELLCARE HEALTH INSURANCE OF ARIZONA, INC.
H2491
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 |
| 001 | 0 | 7 | 'Ohana Reserve (HMO-POS) | HMOPOS | Renewal | 0.00 | 29.80 | 09/21/2010 | 01/01/2011 |
| 002 | 0 | 8 | 'Ohana Value (HMO-POS) | HMOPOS | Renewal | 0.00 | 0.00 | 09/21/2010 | 01/01/2011 |
| 004 | 0 | 8 | 'Ohana Liberty (HMO-POS SNP) | HMOPOS | Renewal | 0.00 | 23.60 | 09/21/2010 | 01/01/2011 |
H2491
| Thomas Tran | 9/2/2010 7:58:15 AM | ||
| Contracting Official Name | Date |
| WELLCARE HEALTH INSURANCE OF ARIZONA , INC. | 8735 Henderson Road Ren 1 Tampa, FL 33634 | ||
| Organization | Address |
H2491
