Medicare Advantage Attestation of Benefit Plan by WellCare of Florida, Inc. (2009)
Summary
WellCare of Florida, Inc. certifies to the Centers for Medicare & Medicaid Services (CMS) that the listed Medicare Advantage plan benefit packages and employer/union group plans will be offered to eligible beneficiaries in the approved service area for 2009. The company attests that the benefits and pricing are accurate and comply with all applicable Medicare regulations and guidance. The document is signed by the CEO and CFO, confirming the company's obligations for the upcoming program year.
EX-10.5 6 g19033exv10w5.htm EX-10.5 EX-10.5
Exhibit 10.5
Medicare Advantage Attestation of Benefit Plan
WELL CARE OF FLORIDA, INC.
H1032
Date: 08/29/2008
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 2009. 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 attest that I have examined the employer/union-only group waiver (“800 series”) PBPs identified below and that these PBPs are those that the above-stated organization will make available only to eligible employer/union-sponsored group plan beneficiaries in the approved service area during program year 2009. I further attest we have reviewed any MA bid pricing tools (BPTs) associated with these PBPs (no Part D bids are required for 2009 “800 series” PBPs) with the certifying actuary and have determined them to be consistent with any MA 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 2008 and 2009, including but not limited to, the 2009 Call Letter, the 2009 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 | Segment | Plan | Transaction | MA | Part D | CMS Approval | Effective | |||||||||||
| ID | ID | Version | Plan Name | Type | Type | Premium | Premium | Date | Date | |||||||||
| 002 | 0 | 11 | WellCare Choice | HMOPOS | Renewal | 31.00 | 4.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 008 | 0 | 7 | WellCare Choice | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 010 | 0 | 6 | WellCare Choice | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 012 | 0 | 6 | WellCare Choice | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 014 | 0 | 6 | WellCare Choice | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 019 | 0 | 6 | WellCare Value | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 025 | 0 | 6 | WellCare Choice | HMOPOS | Renewal | 29.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 028 | 0 | 6 | WellCare Value | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 031 | 0 | 6 | WellCare Dividend | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 032 | 0 | 6 | WellCare Dividend | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 033 | 0 | 6 | WellCare Dividend | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 035 | 0 | 6 | WellCare Value | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 037 | 0 | 5 | WellCare Advance | HMO | Renewal | 0.00 | N/A | 08/29/2008 | 01/01/2009 |
Page 1 of 4 — WELL CARE OF FLORIDA, INC. — H1032 — 08/29/2008
| Plan | Segment | Plan | Transaction | MA | Part D | CMS Approval | Effective | |||||||||||
| ID | ID | Version | Plan Name | Type | Type | Premium | Premium | Date | Date | |||||||||
| 040 | 0 | 6 | WellCare Dividend | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 043 | 0 | 6 | WellCare Dividend | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 044 | 0 | 6 | WellCare Value | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 060 | 0 | 7 | WellCare Select | HMOPOS | Renewal | 0.00 | 15.40 | 08/29/2008 | 01/01/2009 | |||||||||
| 061 | 0 | 8 | WellCare Select | HMOPOS | Renewal | 0.00 | 15.60 | 08/29/2008 | 01/01/2009 | |||||||||
| 064 | 0 | 7 | WellCare Select | HMOPOS | Renewal | 0.00 | 21.50 | 08/29/2008 | 01/01/2009 | |||||||||
| 065 | 0 | 7 | WellCare Select | HMOPOS | Renewal | 0.00 | 5.60 | 08/29/2008 | 01/01/2009 | |||||||||
| 066 | 0 | 6 | WellCare Select | HMOPOS | Renewal | 0.00 | 9.60 | 08/29/2008 | 01/01/2009 | |||||||||
| 069 | 0 | 7 | WellCare Choice | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009. | |||||||||
| 073 | 0 | 11 | WellCare Choice | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 077 | 0 | 5 | WellCare Advance | HMO | Renewal | 0.00 | N/A | 08/29/2008 | 01/01/2009 | |||||||||
| 079 | 0 | 6 | WellCare Value | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 085 | 0 | 7 | WellCare Access | HMO | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 086 | 0 | 7 | WellCare Access | HMO | Renewal | 0.00 | 8.70 | 08/29/2008 | 01/01/2009 | |||||||||
| 088 | 0 | 8 | WellCare Access | HMO | Renewal | 0.00 | 6.20 | 08/29/2008 | 01/01/2009 | |||||||||
| 089 | 0 | 7 | WellCare Access | HMO | Renewal | 0.00 | 14.10 | 08/29/2008 | 01/01/2009 | |||||||||
| 091 | 0 | 6 | WellCare Essential | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 097 | 0 | 9 | WellCare Dividend | HMOPOS | Renewal | 0:00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 098 | 0 | 6 | WellCare Dividend | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 101 | 0 | 7 | WellCare Select | HMOPOS | Renewal | 0.00 | 18.60 | 08/29/2008 | 01/01/2009 | |||||||||
| 102 | 0 | 7 | WellCare Select | HMOPOS | Renewal | 0.00 | 21.50 | 08/29/2008 | 01/01/2009 | |||||||||
| 104 | 0 | 8 | WellCare Select | HMOPOS | Renewal | 0.00 | 11.50 | 08/29/2008 | 01/01/2009 | |||||||||
| 106 | 0 | 7 | WellCare Select | HMOPOS | Renewal | 0.00 | 2.80 | 08/29/2008 | 01/01/2009 | |||||||||
| 107 | 0 | 7 | WellCare Select | HMOPOS | Renewal | 0.00 | 8.90 | 08/29/2008 | 01/01/2009 | |||||||||
| 113 | 0 | 6 | WellCare Value | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 122 | 0 | 7 | WellCare Access | HMO | Renewal | 0.00 | 21.50 | 08/29/2008 | 01/01/2009 | |||||||||
| 123 | 0 | 7 | WellCare Access | HMO | Renewal | 0.00 | 21.50 | 08/29/2008 | 01/01/2009 | |||||||||
| 124 | 0 | 7 | WellCare Access | HMO | Renewal | 0.00 | 11.20 | 08/29/2008 | 01/01/2009 | |||||||||
| 125 | 0 | 7 | WellCare Access | HMO | Renewal | 0.00 | 17.70 | 08/29/2008 | 01/01/2009 |
Page 2 of 4 — WELL CARE OF FLORIDA, INC. — H1032 — 08/29/2008
| Plan | Segment | Plan | Transaction | MA | Part D | CMS Approval | Effective | |||||||||||
| ID | ID | Version | Plan Name | Type | Type | Premium | Premium | Date | Date | |||||||||
| 126 | 0 | 7 | WellCare Select | HMOPOS | Renewal | 0.00 | 17.30 | 08/29/2008 | 01/01/2009 | |||||||||
| 127 | 0 | 7 | WellCare Access | HMO | Renewal | 0.00 | 21.50 | 08/29/2008 | 01/01/2009 | |||||||||
| 128 | 0 | 8 | WellCare Access | HMO | Renewal | 0.00 | 7.70 | 08/29/2008 | 01/01/2009 | |||||||||
| 130 | 0 | 7 | WellCare Access | HMO | Renewal | 0.00 | 1.10 | 08/29/2008 | 01/01/2009 | |||||||||
| 131 | 0 | 6 | WellCare Dividend | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 132 | 0 | 6 | WellCare Value | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 133 | 0 | 6 | WellCare Value | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 136 | 0 | 7 | WellCare Select | HMOPOS | Renewal | 0.00 | 11.60 | 08/29/2008 | 01/01/2009 | |||||||||
| 138 | 0 | 7 | WellCare Access | HMO | Renewal | 0.00 | 21.50 | 08/29/2008 | 01/01/2009’ | |||||||||
| 144 | 0 | 6 | WellCare Value | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 145 | 0 | 6 | WellCare Value | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 146 | 0 | 6 | WellCare Value | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 148 | 0 | 7 | WellCare Access | HMO | Renewal | 0.00 | 18.80 | 08/29/2008 | 01/01/2009 | |||||||||
| 152 | 0 | 8 | WellCare Select | HMOPOS | Renewal | 0.00 | 12.70 | 08/29/2008 | 01/01/2009 | |||||||||
| 153 | 0 | 7 | WellCare Select | HMOPOS | Renewal | 0.00 | 13.70 | 08/29/2008 | 01/01/2009 | |||||||||
| 162 | 0 | 6 | WellCare Select | HMOPOS | Renewal | 0.00 | 10.30 | 08/29/2008 | 01/01/2009 | |||||||||
| 163 | 0 | 8 | WellCare Access | HMO | Renewal | 0.00 | 19.70 | 08/29/2008 | 01/01/2009 | |||||||||
| 164 | 0 | 6 | WellCare Prescription Plus | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 166 | 0 | 8 | WellCare Value Plus | HMOPOS | Renewal | 0.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 168 | 0 | 8 | WellCare Premium | HMOPOS | Renewal | 57.00 | 0.00 | 08/29/2008 | 01/01/2009 | |||||||||
| 801 | 0 | 4 | Employer Florida 1 | HMOPOS | Renewal | 0.00 | N/A | 08/29/2008 | 01/01/2009 | |||||||||
| 802 | 0 | 4 | Employer Florida 2 | HMOPOS | Renewal | 0.00 | N/A | 08/29/2008 | 01/01/2009 | |||||||||
| 803 | 0 | 4 | Employer Florida 3 | HMOPOS | Renewal | 0.00 | N/A | 08/29/2008 | 01/01/2009 | |||||||||
| 804 | 0 | 4 | Employer Florida 4 | HMOPOS | Renewal | 0.00 | N/A | 08/29/2008 | 01/01/2009 |
Page 3 of 4 — WELL CARE OF FLORIDA, INC. — H1032 — 08/29/2008
/s/ Heath Schiesser | 9/5/08 | |||
Heath Schiesser CEO/President 8735 Henderson Road Tampa, FL 33634 813 ###-###-#### | ||||
/s/ Thomas L. Tran | 9/5/08 | |||
Tom Tran CFO 8735 Henderson Road Tampa, FL 33634 813 ###-###-#### (1770) |
Page 4 of 4 — WELL CARE OF FLORIDA, INC. — H1032 — 08/29/2008
