Attached files
Exhibit 10.18
Medicare
Advantage Attestation of Benefit Plan
HARMONY
HEALTH PLAN OF ILLINOIS, INC.
H1416
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
|
|
007
|
0
|
5
|
Well
Care Access
(HMO)
|
HMO
|
Renewal
|
0.00
|
13.80
|
08/31/2009
|
01/01/2010
|
|
009
|
0
|
5
|
WellCare
Value (HMO-
POS)
|
HMOPOS
|
Renewal
|
0.00
|
0.00
|
08/31/2009
|
01/01/2010
|
|
018
|
0
|
5
|
WellCare
Value (HMO-
POS)
|
HMOPOS
|
Renewal
|
0.00
|
0.00
|
08/31/2009
|
01/01/2010
|
|
019
|
0
■
|
5
|
WellCare
Rx (HMO-
POS)
|
HMOPOS
|
Renewal
|
0.00
|
34.90
|
08/31/2009
|
01/01/2010
|
|
020
|
0
|
5
|
WellCare
Rx (HMO-
POS)
|
HMOPOS
|
Renewal
|
0.00
|
29.40
|
08/31/2009
|
01/01/2010
|
Page 1 of
2 - HARMONY HEALTH PLAN OF ILLINOIS, INC. - H1416 -
09/01/2009
|
/s/
Heath Schiesser
|
9/4/09
|
||
|
CEO:
Heath
Schiesser
CEO/President
8735
Henderson Road
Tampa,
FL 33634
813-290-6205
|
Date:
|
||
|
/s/
Thomas L. Tran
|
9/4/09
|
||
|
CFO:
Tom
Tran
CFO
8735
Henderson Road
Tampa,
FL 33634
813-290-6200
(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 21244-1850
Page 2 of
2 - HARMONY HEALTH PLAN OF ILLINOIS, INC. - H1416 -
09/01/2009