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Medicare Advantage Attestation of
Benefit Plan
WELLCARE_OF NEW YORK,
INC.
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 ail
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).
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Plan
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Segment
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Plan
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Transaction
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MA
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Part D
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CMS Approval
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Effective
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ID
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ID
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Version
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Plan Name
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Type
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Type
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Premium
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Premium
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Date
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Date
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020
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0
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6
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HMOPOS
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Renewal
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0.00
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0.00
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08/29/2008
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01/01/2009
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021
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0
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6
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HMOPOS
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Renewal
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0.00
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0.00
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08/29/2008
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01/01/2009
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024
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0
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6
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HMOPOS
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Renewal
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0.00
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0.00
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08/29/2008
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01/01/2009
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027
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0
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6
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HMOPOS
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Renewal
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0.00
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0.00
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08/29/2008
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01/01/2009
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031
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0
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7
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HMO
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Renewal
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0.00
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27.70
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08
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