Common use of Applicable Exhibits Clause in Contracts

Applicable Exhibits. Any additions or variations from Contract requirements specified in Attachments I and II are provided in the exhibits to those attachments. Exhibits required are noted by “X” below depending on health plan type and population served. There are no additional requirements or changes to the Health Plan’s Contract in those exhibits marked N/A. Table 9 – Applicable Exhibits Attachment/ Exhibit* HMO Reform HMO Non- Reform Specialty Plan for Recipients Living with HIV/AIDS Reform Fee- for- Service PSN Non- Reform Capitated PSN Non- Reform Fee- for- Service PSN Reform Capitated PSN Reform Specialty Plan for Children with Chronic Conditions Reform HMO Non- Reform with Frail/ Elderly Program Att. I, Xxx. 0 X X X X X X Xxx. X, Xxx. 1- FFS X X X Att. I, Xxx. 0-XX X X X Xxx. X, Xxx. 2-R X X X Att. I, Exh. 2-FFS-NR X Att.I, Exh. 2-FFS-R X X Att. II, Xxx. 0 X Xxx. XX, Xxx. 2 X X X X X X X X X Xxx. 0, Xxx. 3 X X X X X X X Att. II, Xxx. 0 X X X X X X Xxx. XX, Xxx. 5 X X X X X X X X X Att. II, Exh. 6-HMO&R X X X X X X X Att. II, Exh. 6- PSN-NR X X Att. II, Xxx. 0 X X X X X X Xxx. XX, Xxx. 8 X X X X X X X X X Att. II, Xxx. 0 Xxx. XX, Xxx. 10 X X X X X X X X X Att. II, Exh. 11 X X X X X X X X X Att. II, Xxx. 00 Xxx. XX, Xxx. 13-CAP-R X X X X X Att. II, Xxx. 00-XXX-XX X X X Xxx. XX, Xxx. 13-FFS X X Att. II, Xxx. 00 Xxx. XX, Xxx. 15 X X X X X X X X X Att. II, Exh. 16 X X X X X X X X X * Plans offering certain optional coverage also will have additional language in the exhibits as follows: Exhibits 3, 4, 5, 8 and 13 – Frail/Elderly Program; Exhibit 5 – dental and transportation. Safety net hospital-based PSNs will have additional language in the exhibits as follows: – Exhibit 13 – Method of Payment. WellCare of Florida, Inc. d/b/a Staywell Health Plan of Florida Medicaid HMO Non-Reform Contract

Applicable Exhibits. Any additions or variations from Contract requirements specified in Attachments I and II are provided in the exhibits to those attachments. Exhibits required are noted by “X” below depending on health plan type and population served. There are no additional requirements or changes to the Health Plan’s Contract in those exhibits marked N/A. Table 9 – Applicable Exhibits Attachment/ Exhibit* HMO Reform HMO Non- Non-Reform Specialty Plan for Recipients Living with HIV/AIDS Reform Fee- for- Fee-for-Service PSN Non- Non-Reform Capitated PSN Non- Non-Reform Fee- for- Fee-for-Service PSN Reform Capitated PSN Reform Specialty Plan for Children with Chronic Conditions Reform HMO Non- Non-Reform with Frail/ Elderly Program Att. I, Xxx. 0 X X X X X X Xxx. X, Xxx. 1- 1-FFS X X X Att. I, Xxx. 0-XX X X X Xxx. X, Xxx. 2-R X X X Att. I, Exh. 2-FFS-NR X Att.I, Exh. 2-FFS-R X X Att. II, Xxx. 0 X Xxx. XX, Xxx. 2 X X X X X X X X X Xxx. 0, Xxx. 3 X X X X X X X Att. II, Xxx. 0 X X X X X X Xxx. XX, Xxx. 5 X X X X X X X X X Att. II, Exh. 6-HMO&R X X X X X X X Att. II, Exh. 6- 6-PSN-NR X X Att. II, Xxx. 0 X X X X X X Xxx. XX, Xxx. 8 X X X X X X X X X Att. II, Xxx. 0 Xxx. XX, Xxx. 10 X X X X X X X X X Att. II, Exh. 11 X X X X X X X X X Att. II, Xxx. 00 Xxx. XX, Xxx. 13-CAP-R X X X X X Att. II, Xxx. 00-XXX-XX X X X Xxx. XX, Xxx. 13-FFS X X Att. II, Xxx. 00 Xxx. XX, Xxx. 15 X X X X X X X X X Att. II, Exh. 16 X X X X X X X X X * Plans offering certain optional coverage also will have additional language in the exhibits as follows: Exhibits 3, 4, 5, 8 and 13 – Frail/Elderly Program; Exhibit 5 – dental and transportation. Safety net hospital-based PSNs will have additional language in the exhibits as follows: – Exhibit 13 – Method of Payment. WellCare AHCA Contract No. FA905, Attachment I, Page 8 of 9 HealthEase of Florida, Inc. d/b/a Staywell Health Plan of Florida Medicaid HMO Non-Reform Contract

Applicable Exhibits. Any additions or variations from Contract requirements specified in Attachments I and II are provided in the exhibits to those attachmentsAttachments. Exhibits required are noted denoted by an “X” in Table 10 below depending on health plan type and population served. There are no additional requirements or changes to the Health Plan’s Contract in those exhibits marked N/A. Table 9 – 10 Applicable Exhibits Effective Date: 09/01/12 – 08/31/15 Attachment/ Exhibit* HMO Reform HMO Non- Non-Reform Specialty Plan Plans for Recipients Living with HIV/AIDS Reform Fee- for- Fee-for-Service PSN Non- Non-Reform Capitated PSN Non- Non-Reform Fee- for- Fee-for-Service PSN Reform Capitated PSN Reform Specialty Plan for Children with Chronic Conditions Reform HMO Non- Non-Reform with Frail/ Elderly Program Non-Reform HMOs that Specialize in HIV/AIDS Att. I, XxxExh. 0 1 X X X N/A X N/A X X Xxx. X, Xxx. 1- FFS X X X Att. I, Xxx. 0-XX X X X Xxx. X, Xxx. 2-R X N/A X X Att. I, Exh. 21-FFS N/A N/A N/A X N/A X N/A X N/A N/A Att. I, Exx. 0-XX X/X X X/X X/X X N/A N/A N/A X X Att. I, Exx. 0-X X X/X X X/X X/X X/X X N/A N/A N/A Att. I, Exh.2-FFS-NR N/A N/A N/A X AttN/A N/X X/X X/X X/X X/X Xxx.IX, ExhXxx. 2-FFS-R N/X X/X X/X X/X X/X X N/A X N/A N/A Att. II, XxxExx. 0 X/X X/X X N/A N/A N/X X/X X X/X X Xxx. XX, Xxx. 2 X X X X X X X X X XxxX Axx. 0, Xxx. 3 X N/A X X X X X X Att. II, Xxx. 0 N/X X X X X X Xxx. XX, Xxx. 4 X N/A X N/A N/A X X X X X Att. II, Exh. 5 X X X X X X X X X X Att. II, Exh. 6-HMO&R 6 N/A N/A N/A N/A N/A N/A N/X X/X X/X X/X Xxx. XX, Xxx. 7 X X X X X X X X X X Att. II, Exh. 6- PSN-NR 8 X X Att. II, Xxx. 0 X X X X X X Xxx. XX, Xxx. 8 X X X X X X X X X Att. II, XxxExh. 0 9 N/A N/A N/A N/A N/A N/A N/X X/X X/X X/X Xxx. XX, Xxx. 10 X X X X X X X X X X Att. II, Exh. 11 N/A N/A N/A N/A N/A N/X X/X X/X X/X X/X X X X X AttXxx. IIXX, Xxx. 00 12 N/A N/A N/A N/A N/A N/A N/X X/X X/X X/X Xxx. XX, Xxx. 13-CAP-R X N/A X N/A N/A X X N/X X/X AttX/X Xxx. IIXX, Xxx. 0013-XXXCAP-XX NR N/A X N/A N/A X N/X X/X X/X X X Xxx. XX, Xxx. 13-FFS N/A N/A N/A X N/X X AttX/X X X/X X/X Xxx. IIXX, Xxx. 00 14 N/A N/A N/A N/A N/A N/A N/X X/X X/X X/X Xxx. XX, Xxx. 15 X X X X X X X X X X Att. II, Exh. 16 X X X X X X X X X X * Plans offering certain optional coverage also will have additional language in the exhibits as follows: Exhibits 3, 4, 5, 8 and 13 – Frail/Elderly ProgramProgram and non-Reform HMOs that Specialize in HIV/AIDS; Exhibit 5 – dental and transportation. Safety Safety-net hospital-based PSNs and PSNs that are approved to subcapitate for services will have additional language in the exhibits as follows: – Exhibit 13 – Method of Payment13. . FFS PSNs capitated for transportation and/or behavioral health and approved to subcapitate for services will have additional language in Exhibit 15. WellCare of Florida, Inc. Inc., Medicaid HMO Non-Reform Contract d/b/a Staywell Health Plan of Florida Medicaid HMO Non-Reform ContractHealthEase

Applicable Exhibits. Any additions or variations from Contract requirements specified in Attachments I and II are provided in the exhibits to those attachments. Exhibits required are noted by “X” below depending on health plan type and population served. There are no additional requirements or changes to the Health Plan’s Contract in those exhibits marked N/A. Table 9 – — Applicable Exhibits Attachment/ Exhibit* Specially Fee- Speciality HMO Plan for for- Fee- Plan for Non- Recipients Service Capitated for- Children with Reform HMO Non- Reform Specialty Plan for Recipients Living with PSN PSN Service Capitated Chronic With Frail/ Attachment/ HMO Non- HIV/AIDS Non- Non- PSN PSN Conditions Elderly Exhibit* Reform Fee- for- Service PSN Non- Reform Capitated PSN Non- Reform Fee- for- Service PSN Reform Capitated PSN Reform Specialty Plan for Children with Chronic Conditions Reform HMO Non- Reform with Frail/ Elderly Reform Program Att. I, XxxI. Exh. 0 1 X X X X X X XxxAtt. X, XxxI. Exh. 1- 1-FFS X X X Att. I, I. Xxx. 0-XX X X X XxxAtt. X, XxxI. Exh. 2-R X X X Att. I, I. Exh. 2-FFS-NR X Att.I, . I. Exh. 2-FFS-R X X Att. II, . Xxx. 0 X Xxx. XX, . Xxx. 2 X X X X X X X X X XxxAtt. 0, Xxx2. Exh. 3 X X X X X X X Att. II, Xxx. 0 Exh. 4 X X X X X X Att. II. Xxx. XX, Xxx. 5 0 X X X X X X X X X Att. II, . Exh. 6-6 HMO&R X X X X X X X Att. II, Exh. 6- PSNXxx. 0 XXX-NR XX X X Att. II, Xxx. 0 Exh. 7 X X X X X X Att. II. Xxx. XX, Xxx. 8 0 X X X X X X X X X Att. II, . Xxx. 0 Xxx. XX, . Xxx. 10 X X X X X X X X X Att. II, Exh. 11 Xxx. 00 X X X X X X X X X Att. II, . Xxx. 00 Xxx. XX, . Xxx. 13-CAP-R X X X X X Att. II, Xxx. 00Exh. 13-XXXCAP-XX NR X X X XxxAtt. XX, XxxII. Exh. 13-FFS X X Att. II, . Xxx. 00 Xxx. XX, . Xxx. 15 X X X X X X X X X Att. II, Exh. 16 Xxx. 00 X X X X X X X X X * Plans offering certain optional coverage also will have additional language in the exhibits as follows: Exhibits 3, 4, 5, 8 and 13 – — Frail/Elderly Program; Exhibit 5 – — dental and transportation. Safety net hospital-based PSNs will have additional language in the exhibits as follows: – — Exhibit 13 – — Method of Payment. WellCare AHCA Contract No. FA913, Attachment I, Page 8 of 11 AMERIGROUP Florida, Inc. Medicaid Non-Reform and Reform d/b/a Staywell Health Plan of Florida Medicaid AMERIGROUP Community Care HMO Non-Reform Contract

Applicable Exhibits. Any additions or variations from Contract requirements specified in Attachments I and II are provided in the exhibits to those attachmentsAttachments. Exhibits required are noted denoted by an “X” in Table 10 below depending on health plan type and population served. There are no additional requirements or changes to the Health Plan’s Contract in those exhibits marked N/A. Table 9 – 10 Applicable Exhibits Effective Date: 09/01/12 – 08/31/15 Attachment/ Exhibit* HMO Reform HMO Non- Non-Reform Specialty Plan Plans for Recipients Living with HIV/AIDS Reform Fee- for- Fee-for-Service PSN Non- Non-Reform Capitated PSN Non- Non-Reform Fee- for- Fee-for-Service PSN Reform Capitated PSN Reform Specialty Plan for Children with Chronic Conditions Reform HMO Non- Non-Reform with Frail/ Elderly Program Non-Reform HMOs that Specialize in HIV/AIDS Att. I, Exh. 1 X X X N/A X N/A X N/A X X Att. I, Exh. 1-FFS N/A N/A N/A X N/A X N/A X N/A N/A Att. I, Xxx. 0 0-XX X/X X X/X X/X X X X Xxx. X, Xxx. 1- FFS X N/A N/A N/A X X Att. I, Xxx. 0-XX X X X/X X X/X X/X X/X X N/A N/A N/A Att. I, Exh.2-FFS-NR N/A N/A N/A X N/A X/X X/X X/X X/X X/X Xxx. .X, Xxx. 2-R X X X Att. I, Exh. 2-FFS-NR X Att.I, Exh. 2-FFS-R X/X X/X X/X X/X X/X X N/A X N/A N/A Att. II, Xxx. 0 X/X X/X X N/A N/A X/X X/X X X/X X Xxx. XX, Xxx. 2 X X X X X X X X X X Xxx. 0, Xxx. 3 X N/A X X X X X X Att. II, Xxx. 0 X/X X X X X X Xxx. XX, Xxx. 4 X N/A X N/A N/A X X X X X Att. II, Exh. 5 X X X X X X X X X X Att. II, Exh. 6-HMO&R 6 N/A N/A N/A N/A N/A N/A X/X X/X X/X X/X Xxx. XX, Xxx. 7 X X X X X X X X X X Att. II, Exh. 6- PSN-NR 8 X X Att. II, Xxx. 0 X X X X X X Xxx. XX, Xxx. 8 X X X X X X X X X Att. II, XxxExh. 0 9 N/A N/A N/A N/A N/A N/A X/X X/X X/X X/X Xxx. XX, Xxx. 10 X X X X X X X X X X Att. II, Exh. 11 N/A N/A N/A N/A N/A X/X X/X X/X X/X X/X X X X X AttXxx. IIXX, Xxx. 00 12 N/A N/A N/A N/A N/A N/A X/X X/X X/X X/X Xxx. XX, Xxx. 13-CAP-R X N/A X N/A N/A X X X/X X/X AttX/X Xxx. IIXX, Xxx. 0013-XXXCAP-XX NR N/A X N/A N/A X X/X X/X X/X X X Xxx. XX, Xxx. 13-FFS N/A N/A N/A X X/X X AttX/X X X/X X/X Xxx. IIXX, Xxx. 00 14 N/A N/A N/A N/A N/A N/A X/X X/X X/X X/X Xxx. XX, Xxx. 15 X X X X X X X X X X Att. II, Exh. 16 X X X X X X X X X X * Plans offering certain optional coverage also will have additional language in the exhibits as follows: Exhibits 3, 4, 5, 8 and 13 – Frail/Elderly ProgramProgram and non-Reform HMOs that Specialize in HIV/AIDS; Exhibit 5 – dental and transportation. Safety Safety-net hospital-based PSNs and PSNs that are approved to subcapitate for services will have additional language in the exhibits as follows: – Exhibit 13 – Method of Payment13. . FFS PSNs capitated for transportation and/or behavioral health and approved to subcapitate for services will have additional language in Exhibit 15. WellCare of Florida, Inc. Inc., Medicaid HMO Non-Reform Contract d/b/a Staywell Health Plan of Florida Medicaid HMO Non-Reform ContractFlorida