2011 Benefit Attestation to Contract H3361 between the Centers for Medicare & Medicaid Services and WellCare of New York, Inc

Medicare Advantage Attestation of Benefit Plan

 

WELLCARE OF NEW YORK, INC.

 

H3361

 

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 2011.1 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
039	0	4	WellCare Dividend (HMO)	HMO	Renewal	0.00	N/A	09/03/2010	01/01/2011
043	0	7	WellCare Liberty (HMO SNP)	HMO	Renewal	0.00	35.10	9/3/2010	01/01/2011
059	0	4	WellCare Advance (HMO)	HMO	Renewal	0.00	N/A	9/3/2010	01/01/2011
065	0	5	WellCare Access (HMO SNP)	HMO	Renewal	0.00	30.60	9/3/2010	01/01/2011
098	0	6	WellCare Liberty (HMO SNP)	HMO	Renewal	0.00	16.90	9/3/2010	01/01/2011
099	0	6	WellCare Value (HMO)	HMO	Renewal	0.00	0.00	9/3/2010	01/01/2011
105	0	7	WellCare Advocate Complete (HMO SNP)	HMO	Renewal	0.00	30.60	9/3/2010	01/01/2011
106	0	5	WellCare Choice (HMO- POS)	HMOPOS	Renewal	0.00	0.00	9/3/2010	01/01/2011
109	0	5	WellCare Access (HMO SNP)	HMO	Renewal	0.00	38.70	09/03/2010	01/01/2011
127	0	7	WellCare Value (HMO)	HMO	Renewal	0.00	0.00	9/3/2010	01/01/2011