2010 Medicare Advantage Benefit Attestation Agreement between WellCare of Louisiana, Inc. and CMS
Summary
WellCare of Louisiana, Inc. attests to the Centers for Medicare & Medicaid Services (CMS) that its 2010 Medicare Advantage plans, including WellCare Advance, WellCare Access, and WellCare Value, will provide the stated benefits to eligible beneficiaries in the approved service area. The company confirms that its plan benefits and pricing are accurate and comply with all applicable Medicare regulations and guidance. The attestation is signed by the CEO and CFO, and is effective for the 2010 program year.
EX-10.22 12 h1903cmsrenewal.htm 2010 BENEFIT ATTESTATION FOR CONTRACT H1903 h1903cmsrenewal.htm
Back to Form 8-K
Exhibit 10.22
Medicare Advantage Attestation of Benefit Plan
WELLCARE OF LOUISIANA, INC.
H1903
Date: 09/01/2009
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 2010. 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 2009 and 2010, including but not limited to, the 2010 Call Letter, the 2010 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 |
| 005 | 0 | 3 | WellCare Advance (HMO) | HMO | Renewal | 0.00 | N/A | 08/28/2009 | 01/01/2010 |
| 011 | 0 | 5 | WellCare Access (HMO) | HMO | Renewal | 0.00 | 31.30 | 08/31/2009 | 01/01/2010 |
| 022 | 0 | 5 | WellCare Value (HMO- POS) | HMOPOS | Renewal | 0.00 | 0.00 | 08/31/2009 | 01/01/2010 |
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| /s/ Heath Schiesser | 9/4/09 | ||
| CEO: Heath Schiesser CEO/President 8735 Henderson Road Tampa, FL 33634 813 ###-###-#### | Date: | ||
| /s/ Thomas L. Tran | 9/4/09 | ||
| CFO: Tom Tran CFO 8735 Henderson Road Tampa, FL 33634 813 ###-###-#### (1770) | Date: |
Medicare Advantage benefit attestations should be sent by overnight carrier to:
Centers for Medicare & Medicaid Services
ATTN: Marilyn Hunter/Medicare Advantage Benefit Attestation
Mail Stop C4-22-04
7500 Security Boulevard
Baltimore, MD ###-###-####
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