EMPLOYER/UNION-ONLY GROUP PART D ADDENDUM TO CONTRACT WITH APPROVED ENTITY PURSUANT TO SECTIONS 1860D-1 THROUGH 1860D-42 OF THE SOCIAL SECURITY ACT FOR THE OPERATION OF A VOLUNTARY MEDICARE PRESCRIPTION DRUG PLAN
Exhibit
10.13
EMPLOYER/UNION-ONLY
GROUP PART D ADDENDUM TO CONTRACT WITH APPROVED ENTITY PURSUANT TO SECTIONS
1860D-1 THROUGH 1860D-42 OF THE SOCIAL SECURITY ACT FOR THE OPERATION OF
A
VOLUNTARY MEDICARE PRESCRIPTION DRUG PLAN
The
Centers for Medicare & Medicaid Services (hereinafter referred to as "CMS")
and WellCare
Prescription Insurance, Inc., a Prescription Drug Plan (PDP) Sponsor
(hereinafter referred to as the "PDP Sponsor"), agree to amend the contract
S^§^7goveming the PDP Sponsor's operation of one or more Voluntary Medicare
Prescription Drug Plans, pursuant to sections 1860D-1 through 1860D-42 of
the
Social Security Act (hereinafter referred to as "the Act"), to permit PDP
Sponsor to offer Employer/Union-Only Group Part D Prescription Drug Plans
(hereinafter referred to in this Addendum as "employer/union-only group PDPs")
in accordance with the waivers granted by CMS under section 1860D-22(b) of
the
Act. The terms of this Addendum shall only apply to PDPs offered exclusively
to
employers/unions.
This
Addendum is made pursuant to Subpart K of 42 CFR Part 423.
Page
1
of 9
ARTICLE
I
VOLUNTARY
MEDICARE PRESCRIPTION DRUG PLAN
A.
PDP
Sponsor agrees to operate one or more employer/union-only group PDPs in
accordance with the terms of this Addendum, the Medicare Prescription Drug
Plan
contract, which incorporates in its entirety: either the 2006 Solicitation
For
Applications from Prescription Drug Plans released on January 21, 2005 (as
revised on March 9, 2005) or the 2007 Solicitation for Applications For New
Prescription Drug Plans released on January 27, 2006 (as revised on February
2,
2006), as modified by the 2007 Application For PDP Sponsors To Offer New
Employer/Union-Only Group Waiver Plans (EGWPs) (released on January 27, 2006)
(except for requirements contained therein that are expressly waived or modified
by this Addendum); all provisions of Federal statutes, regulations, and policies
applicable to PDP Sponsors and PDPs (except to the extent any such provisions
are expressly waived or modified by this Addendum); and any employer/union-only
group waiver guidance. PDP Sponsor also agrees to operate one or more
employer/union-only group PDPs in accordance with the regulations at 42 CFR
§423.1 through 42 CFR §423.910 (with the exception of Subparts Q, R, and S),
sections 1860D-1 through 1860D-42 of the Act (with the exception of 1860D-22(a)
and 1860D-31), and the applicable solicitations/applications, as well as
all
other applicable Federal statutes, regulations, and policies, including any
employer/union-only group waiver guidance.
B.
This
Addendum is deemed to incorporate any changes that are required by statute
to be
implemented during the term of the contract, and any regulations and policies
implementing or interpreting such statutory provisions.
C.
In the
event of any conflict between the employer/union-only group waiver guidance
issued prior to the execution of the contract and this Addendum, the provisions
of this Addendum shall control. In the event of any conflict between the
employer/union-only group waiver guidance issued after the execution of the
contract and this Addendum, the provisions of the employer/union-only group
guidance shall control.
D.
This
Addendum is in no way intended to supersede or modify 42 CFR Part 423 or
section
1860D-1 through D-42 of the Act, except as specifically provided in applicable
employer/union-only group waiver guidance and/or in this Addendum. Failure
to
reference a regulatory requirement in this Addendum does not affect the
applicability of such requirement to the PDP Sponsor and CMS.
E.
The
provisions of this Addendum apply to all employer/union-only group PDPs offered
by PDP Sponsor under this contract number. In the event of any conflict between
the provisions of this Addendum and any other provision of the contract,
the
terms of this Addendum shall control.
Page
2 of
9
ARTICLE
II
FUNCTIONS
TO BE PERFORMED BY THE PDP SPONSOR
A.
ENROLLMENT
1.
PDP
Sponsor agrees to restrict enrollment in an employer/union-only group PDP
to
those Part D eligible individuals eligible for the employer's/union's
employment-based retiree prescription drug coverage. PDP Sponsor agrees not
to
enroll active employees of an employer/union in its employer/union-only group
PDPs.
2.
PDP
Sponsor will not be subject to the requirement to offer the employer/union-only
group PDP to all Part D eligible beneficiaries residing in its service area
as
set forth in 42 CFR §423.104(b).
3.
If an
employer/union elects to enroll Part D eligible individuals eligible for
its
employer/union-only group PDP through a group enrollment process, PDP Sponsor
will not be subject to the individual enrollment requirements set forth in
42
CFR §423.32(b). PDP Sponsor agrees that all Part D eligible individuals eligible
for its employer/union-only group PDP will be advised that the employer/union
contracting with PDP sponsor to offer an employer/union-only group PDP
(hereinafter referred to as "employer/union") intends to enroll them into
the
plan through a group enrollment process unless the individual affirmatively
opts
out of such enrollment. PDP Sponsor agrees that all such individuals will
be
provided this information at least 30 days prior to the effective date of
the
individual's enrollment in the employer/union-only group PDP. PDP Sponsor
agrees
the information must include a summary of benefits offered under the
employer/union-only group PDP, an explanation of how to get more information
on
such plan, and an explanation of how to contact Medicare for information
on
other Part D plans that might be available to the individual. In addition,
PDP
Sponsor agrees that all information necessary to effectuate enrollment must
be
submitted electronically to CMS, consistent with CMS instructions.
B.
PRESCRIPTION DRUG BENEFIT
1.
(a) Except as provided in II.X.x(b), PDP Sponsor agrees to provide basic
prescription drug coverage, as defined under 42 CFR §423.100, under any
employer/union-only group PDP, in accordance with Subpart C of 42 CFR Part
423.
PDP Sponsor also agrees to provide Part D benefits under any employer/union-only
group PDP as described in PDP Sponsor's bid approved each year by
CMS.
(b)
CMS
agrees that PDP Sponsor will not be subject to the actuarial equivalence
requirement set forth in 42 CFR §423.104(e)(5) with respect to any
employer/union-only group PDP and may provide less than the defined standard
coverage
between the deductible and initial coverage limit. PDP Sponsor agrees that
its
basic prescription drug coverage under any employer/union-only group PDP
will
satisfy all of the other actuarial equivalence standards set forth in 42
CFR
§423.104, including but not limited to the requirement set forth in 42 CFR
§423.104(e)(3) that the plan has a total or gross value that is at least equal
to the total or gross value of defined standard coverage.
Page
3 of
9
(c)
CMS
agrees that nothing in this Addendum prevents PDP Sponsor from offering benefits
in addition to basic prescription drug coverage to employers/unions. Such
additional benefits offered pursuant to private agreements between PDP Sponsor
and employers/unions will be considered non-Medicare Part D benefits. PDP
Sponsor agrees that such additional benefits may not reduce the value of
basic
prescription drug coverage (e.g., additional benefits cannot impose a cap
that
would preclude enrollees from realizing the full value of such basic
prescription drug coverage).
(d)
PDP
Sponsor agrees that enrollees of employer/union-only group PDPs shall not
be
charged more than the sum of his or her monthly beneficiary premium attributable
to basic prescription drug coverage and 100% of the monthly beneficiary premium
attributable to his or her supplemental prescription drug coverage (if any).
PDP
Sponsor must pass through the direct subsidy payments received from CMS to
reduce the amount that the beneficiary pays.
(e)
PDP
Sponsor agrees that any additional non-Medicare Part D benefits offered to
an
employer/union will always pay primary to the subsidies provided by CMS to
low-income individuals under Subpart P of 42 CFR Part 423 (the "Low-Income
Subsidy").
2.
PDP
Sponsor agrees enrollees of employer/union-only group PDPs will not be permitted
to make payment of premiums under 42 CFR §423.293(a) through withholding from
the enrollee's Social Security, Railroad Retirement Board, or Office of
Personnel Management benefit payment.
3.
PDP
Sponsor agrees it shall obtain written agreements from each employer/union
that
provide that the employer/union may determine how much of an enrollee's Part
D
monthly beneficiary premium it will subsidize, subject to the restrictions
set
forth in II.B.3(a) through (e). PDP Sponsor agrees to retain these written
agreements with employers/unions and provide access to these written agreements
to CMS in accordance with 42 CFR §§423.504(d) and 423.505(d) and
(e).
(a)
The
employer/union can subsidize different amounts for different classes of
enrollees in the employer/union-only group PDP provided such classes are
reasonable and based on objective business criteria, such as years of service,
date of retirement, business location, job category, and nature of compensation
(e.g., salaried v. hourly). Different classes cannot be based on eligibility
for
the Low Income Subsidy.
Page
4 of
9
(b)
The
employer/union cannot vary the premium subsidy for individuals within a given
class ofenrollees.
(c)
The
employer/union cannot charge an enrollee for prescription drug coverage provided
under the plan more than the sum of his or her monthly beneficiary premium
attributable to basic prescription drug coverage and 100% of the monthly
beneficiary premium attributable to his or her supplemental prescription
drug
coverage (if any). The employer/union must pass through direct subsidy payments
received from CMS to reduce the amount that the beneficiary pays.
(d)
For
all enrollees eligible for the Low Income Subsidy, the low income premium
subsidy amount will first be used to reduce the portion of the monthly
beneficiary premium attributable to basic prescription drug coverage paid
by the
enrollee, with any remaining portion of the premium subsidy amount then applied
toward the portion of the monthly beneficiary premium attributable to basic
prescription drug coverage paid by the employer/union.
(e)
If
the low income premium subsidy amount for which an enrollee is eligible is
less
than the portion of the monthly beneficiary premium paid by the enrollee,
then
the employer/union should communicate to the enrollee the financial consequences
for the beneficiary of enrolling in the employer/union-only group PDP as
compared to enrolling in another Part D plan with a monthly beneficiary premium
equal to or below the low income premium subsidy amount.
4.
For
non-calendar year employer/union-only group PDPs, PDP Sponsor may determine
benefits (including deductibles, out-of-pocket limits, etc.) on a non-calendar
year basis subject to the following requirements:
(a)
Applications, formularies, bids and other submissions to CMS must be submitted
on a calendar year basis;
(b)
The
employer/union-only group PDP must be actuarially equivalent to defined standard
coverage for the portion of its plan year that falls in a given calendar
year.
An employer/union-only group PDP will meet this standard if it is actuarially
equivalent for the calendar year in which the plan year starts and no design
change is made for the remainder of the plan year. In no event can PDP Sponsor
increase during the plan year the annual out-of-pocket threshold;
(c)
After
an enrollee's incurred costs exceed the annual out-of-pocket threshold, the
employer/union-only group PDP must provide coverage that is at least actuarially
equivalent to that provided under standard prescription drug coverage;
eligibility
for such coverage can be determined on a plan year basis.
Page
5 of
9
C.
DISSEMINATION OF EMPLOYER/UNION-ONLY GROUP PLAN INFORMATION
1.
Except
as provided in II.C.2., CMS agrees that with respect to any employer/union-only
group PDPs, PDP Sponsor will not be subject to the information requirements
set
forth in 42 CFR §423.48 and the prior review and approval of marketing materials
and enrollment forms requirements set forth in 42 CFR §423.50. PDP Sponsor will
be subject to all other dissemination requirements contained in 42 CFR §423.128
and in CMS guidance, including those requirements contained in the "Medicare
Marketing Materials Guidelines for Medicare Advantage Plans (MAs), Medicare
Advantage Prescription Drug Plans (MA-PDs), Prescription Drug Plans (PDPs),
and
1876 Cost Plans."
2.
CMS
agrees that the dissemination requirements set forth in 42 CFR §423.128 will not
apply with respect to any employcr/union-only group PDP when the employer/union
is subject to alternative disclosure requirements (e.g., the Employee Retirement
Income Security Act of 1974 ("ERISA")) and fully complies with such alternative
requirements. PDP Sponsor agrees to comply with the requirements for this
waiver
contained in employer/union-only group waiver guidance, including those
requirements contained in Chapter 13 of the "Medicare Marketing Materials
Guidelines for Medicare Advantage Plans (MAs), Medicare Advantage Prescription
Drug Plans (MA-PDs), Prescription Drug Plans (PDPs), and 1876 Cost
Plans."
D.
PAYMENT TO PDP SPONSOR
Except
as
provided in II.D.l through 3 of this section, payment under this Addendum
will
be governed by the rules ofSubpart G of 42 CFR Part 423.
1.
PDP
Sponsor will receive a monthly direct subsidy for each employer/union-only
group
PDP enrollee equal to the amount of the national average monthly bid amount
(not
its approved standardized bid), adjusted for health status (as determined
under
42 CFR §423.329(b)(l)) and reduced by the base beneficiary premium for the
employer/union-only group PDP, as adjusted under 42 CFR §423.286(d)(3), if
applicable. The further adjustments to the base beneficiary premium contained
in
42 CFR §423.286(d)(l) and (2) will not apply.
2.
PDP
Sponsor agrees that the risk-sharing payment adjustment described in 42 CFR
§423.336 is not applicable for any employer/union-only group PDP
enrollee.
3.
PDP
Sponsor will not receive monthly reinsurance payment amounts in the manner
set forth in 42 CFR §423.329(c)(2)(i) for any employer/union-only group PDP
enrollee, but instead will receive the full reinsurance payment following
the
end of year reconciliation as described in 42 CFR
§423.329(c)(2)(ii).
Page
6 of
9
4.
For
non-calendar year plans:
(a)
CMS
payments will be determined on a calendar year basis;
(b)
Low
income subsidy payments and reconciliations will be determined based on the
calendar year for which the payments are made; and
(c)
PDP
Sponsor acknowledges that it will not receive reinsurance payments under
42 CFR
§423.329(c).
E.
SERVICE AREA, FORMULARIES, AND PHARMACY ACCESS
1.
CMS
agrees that PDP Sponsor may offer an employer/union-only group PDP in any
PDP
region in which PDP Sponsor, either itself or through subcontractors or other
partners, offers a PDP to Part D eligible individuals not participating in
an
employer/union-only group PDP (hereinafter referred to as a "non-group PDP").
PDP Sponsor may extend coverage under an employer/union-only group PDP to
other
PDP regions in which eligible individuals reside, provided the PDP Sponsor,
either itself or through subcontractors or other partners, offers a non-group
PDP in the PDP region where the most substantial portion of the employer's
employees (or in the case of a union, the union's participants) reside. PDP
Sponsor agrees to conduct an actual review to identify where the most
substantial portion of the employer's/union's employees/participants reside,
and
to maintain adequate supporting documentation of such review (including the
date
of such review, by whom the review was conducted, and any other relevant
documentation to substantiate the review), and to permit CMS to audit and
review
such documentation. Such expanded service areas must have convenient Part
D
pharmacy access sufficient to meet the needs of enrollees wherever they
reside.
2.
PDP
Sponsor agrees to utilize, as the formulary for any employer/union-only
group
PDP, a base formulary that has received approval from CMS, in accordance
with
CMS formulary guidance, for use in a non-group PDP offered by PDP sponsor.
Except as set forth in 42 CFR §423.120(b) and sub-regulatory guidance, PDP
Sponsor may not modify the approved base formulary used for any
employer/union-only group PDP by removing drugs, adding additional utilization
management restrictions, or increasing the cost-sharing status of a drug
from
the base formulary. Enhancements that are permitted to the base formulary
include adding additional drugs, removing utilization management restrictions,
and improving the cost-sharing status of drugs.
3.
For
any employer/union-only group PDP, PDP Sponsor agrees to provide Part D benefits
in the plan's service area utilizing a pharmacy network and formulary that
meets
the requirements of 42 CFR §423.120, with the following exception:
CMS
agrees that the retail pharmacy access requirements set forth in 42 CFR
§423.120(a)(l) ("Tricare" standards) will not apply when the employer/union-only
group PDP's pharmacy network is sufficient to meet the needs of its
Page
7 of
9
enrollees
throughout the employer/union-only group PDP's service area, as determined
by
CMS. CMS may periodically review the adequacy of the employ er/union-only
group
PDP's pharmacy network and require the employer/union-only group PDP to expand
access if CMS determines that such expansion is necessary in order to ensure
that the employer/union-only group PDP's network is sufficient to meet the
needs
of its enrollees.
Page
8 of
9
In
witness whereof, the parties hereby execute this Addendum.
FOR
THE
PDP SPONSOR
|
Xxxx
Xxxxx
Xxxxxx
Name
|
President
and CEO
Title
|
|
/s/
Xxxx X. Xxxxx
Signature
|
9/6/06
Date
|
|
WellCare
Prescription Insurance, Inc.
Organization
|
0000
Xxxxxxxxx Xx. Tampa, FL 33634
Address
|
|
FOR
THE CENTERS FOR MEDICARE & MEDICAID SERVICES
|
|
|
/s/
Xxxxxx Xxxxxxxxx
Xxxxxx
Xxxxxxxxx
Deputy
Director
Employer
Policy & Operations Group
Center
for Beneficiary Choices
|
9/21/06
Date
|
Prescription
Drug Plan Attestation of Benefit Plan and Price
WELLCARE
PRESCRIPTION INSURANCE, INC.
S5967
Date:
09/05/2006
I
attest
that the following plan numbers as established in the final Plan Benefit
Package
(PBP) will be operated by the above-stated organization and made available
to
eligible beneficiaries in the approved service area during program year
2007.I
further attest that the organization will comply with all applicable program
guidance that CMS has issued to date and will issue during the remainder
of 2006
and 2007 pursuant to Medicare program authorizing statutes and regulations,
including but not limited to, the 2007 Call Letters, the 2007 Solicitations
for
New Contract Applicants, and the CMS memoranda issued through the Health
Plan
Management System (HPMS).
|
Plan
ID
|
Segment
ID
|
Version
|
Plan
Name
|
Plan
Type
|
Transaction
Type
|
Part
D Premium
|
CMS
Approval Date
|
Effective
Date
|
|
035
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
26.10
|
08/31/2006
|
01/01/2007
|
|
036
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
21.50
|
08/31/2006
|
01/01/2007
|
|
037
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
22.70
|
08/31/2006
|
01/01/2007
|
|
038
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
22.60
|
08/31/2006
|
01/01/2007
|
|
039
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
20.40
|
08/31/2006
|
01/01/2007
|
|
040
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
27.10
|
08/31/2006
|
01/01/2007
|
|
041
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
26.30
|
08/31/2006
|
01/01/2007
|
|
042
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
27.70
|
08/31/2006
|
01/01/2007
|
|
043
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
27.80
|
08/31/2006
|
01/01/2007
|
|
044
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
27.80
|
08/31/2006
|
01/01/2007
|
|
045
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
17.80
|
08/31/2006
|
01/01/2007
|
|
046
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
30.00
|
08/31/2006
|
01/01/2007
|
Page 1
of 9 - WELLCARE PRESCRIPTION INSURANCE, INC.
-
S5967
|
Plan
ID
|
Segment
ID
|
Version
|
Plan
Name
|
Plan
Type
|
Transaction
Type
|
Part
D Premium
|
CMS
Approval Date
|
Effective
Date
|
|
047
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
25.30
|
08/31/2006
|
01/01/2007
|
|
048
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
28.20
|
08/31/2006
|
01/01/2007
|
|
049
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
28.90
|
08/31/2006
|
01/01/2007
|
|
050
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
24.50
|
08/31/2006
|
01/01/2007
|
|
051
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
25.90
|
08/31/2006
|
01/01/2007
|
|
052
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
23.80
|
08/31/2006
|
01/01/2007
|
|
053
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
23.20
|
08/31/2006
|
01/01/2007
|
|
054
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
27.90
|
08/31/2006
|
01/01/2007
|
|
055
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
26.00
|
08/31/2006
|
01/01/2007
|
|
056
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
19.40
|
08/31/2006
|
01/01/2007
|
|
057
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
27.80
|
08/31/2006
|
01/01/2007
|
|
058
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
28.00
|
08/31/2006
|
01/01/2007
|
|
059
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
26.80
|
08/31/2006
|
01/01/2007
|
Page
2 of
9 - WELLCARE PRESCRIPTION INSURANCE, INC. - S5967 - 09/05/2006
|
Plan
ID
|
Segment
ID
|
Version
|
Plan
Name
|
Plan
Type
|
Transaction
Type
|
Part
D Premium
|
CMS
Approval Date
|
Effective
Date
|
|
060
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
25.40
|
08/31/2006
|
01/01/2007
|
|
061
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
26.30
|
08/31/2006
|
01/01/2007
|
|
062
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
18.20
|
08/31/2006
|
01/01/2007
|
|
063
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
19.80
|
08/31/2006
|
01/01/2007
|
|
064
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
29.50
|
08/31/2006
|
01/01/2007
|
|
065
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
30.00
|
08/31/2006
|
01/01/2007
|
|
066
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
18.20
|
08/31/2006
|
01/01/2007
|
|
067
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
27.10
|
08/31/2006
|
01/01/2007
|
|
068
|
0
|
4
|
WellCare
Signature
|
Medicare
Prescription Drug Plan
|
Renewal
|
36.30
|
08/31/2006
|
01/01/2007
|
|
069
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
45.80
|
08/31/2006
|
01/01/2007
|
|
070
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
36.80
|
08/31/2006
|
01/01/2007
|
|
071
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
39.10
|
08/31/2006
|
01/01/2007
|
|
072
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
42.20
|
08/31/2006
|
01/01/2007
|
|
073
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
37.20
|
08/31/2006
|
01/01/2007
|
|
|
074
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
46.60
|
08/31/2006
|
01/01/2007
|
Page
3 of 9 - WELLCARE PRESCRIPTION INSURANCE, INC. -
S5967 - 09/05/2006
|
Plan
ID
|
Segment
ID
|
Version
|
Plan
Name
|
Plan
Type
|
Transaction
Type
|
Part
D Premium
|
CMS
Approval Date
|
Effective
Date
|
|
075
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
42.50
|
08/31/2006
|
01/01/2007
|
|
076
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
47.90
|
08/31/2006
|
01/01/2007
|
|
077
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
42.80
|
08/31/2006
|
01/01/2007
|
|
078
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
45.40
|
08/31/2006
|
01/01/2007
|
|
079
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
41.40
|
08/31/2006
|
01/01/2007
|
|
080
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
49.70
|
08/31/2006
|
01/01/2007
|
|
081
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
42.50
|
08/31/2006
|
01/01/2007
|
|
082
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
53.40
|
08/31/2006
|
01/01/2007
|
|
083
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
46.90
|
08/31/2006
|
01/01/2007
|
|
084
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
45.50
|
08/31/2006
|
01/01/2007
|
|
085
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
47.10
|
08/31/2006
|
01/01/2007
|
|
086
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
46.50
|
08/31/2006
|
01/01/2007
|
|
087
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
35.70
|
08/31/2006
|
01/01/2007
|
|
088
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
43.00
|
08/31/2006
|
01/01/2007
|
|
089
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
45.30
|
08/31/2006
|
01/01/2007
|
|
090
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
33.60
|
08/31/2006
|
01/01/2007
|
Page 4
of 9 - WELLCARE PRESCRIPTION INSURANCE,
INC. - S5967 - 09/05/2006
|
Plan
ID
|
Segment
ID
|
Version
|
Plan
Name
|
Plan
Type
|
Transaction
Type
|
Part
D Premium
|
CMS
Approval Date
|
Effective
Date
|
|
092
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
40.60
|
08/31/2006
|
01/01/2007
|
|
093
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
46.00
|
08/31/2006
|
01/01/2007
|
|
094
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
39.50
|
08/31/2006
|
01/01/2007
|
|
095
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
33.30
|
08/31/2006
|
01/01/2007
|
|
096
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
39.30
|
08/31/2006
|
01/01/2007
|
|
097
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
38.30
|
08/31/2006
|
01/01/2007
|
|
098
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
43.10
|
08/31/2006
|
01/01/2007
|
|
099
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
43.80
|
08/31/2006
|
01/01/2007
|
|
100
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
45.60
|
08/31/2006
|
01/01/2007
|
|
101
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
35.50
|
08/31/2006
|
01/01/2007
|
|
102
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
42.60
|
08/31/2006
|
01/01/2007
|
|
103
|
0
|
1
|
WellCare
Complete
|
Medicare
Prescription Drug Plan
|
Renewal
|
58.40
|
08/31/2006
|
01/01/2007
|
|
138
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
21.70
|
08/31/2006
|
01/01/2007
|
|
139
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
13.40
|
08/31/2006
|
01/01/2007
|
|
140
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
14.90
|
08/31/2006
|
01/01/2007
|
Page 5
of 9 - WELLCARE PRESCRIPTION INSURANCE,
INC. - S5967 - 09/05/2006
|
Plan
ID
|
Segment
ID
|
Version
|
Plan
Name
|
Plan
Type
|
Transaction
Type
|
Part
D Premium
|
CMS
Approval Date
|
Effective
Date
|
|
141
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
15.10
|
08/31/2006
|
01/01/2007
|
|
142
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
12.20
|
08/31/2006
|
01/01/2007
|
|
143
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
19.90
|
08/31/2006
|
01/01/2007
|
|
144
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
19.00
|
08/31/2006
|
01/01/2007
|
|
145
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
22.00
|
08/31/2006
|
01/01/2007
|
|
146
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
20.50
|
08/31/2006
|
01/01/2007
|
|
147
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
20.70
|
08/31/2006
|
01/01/2007
|
|
148
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
10.20
|
08/31/2006
|
01/01/2007
|
|
149
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
20.70
|
08/31/2006
|
01/01/2007
|
|
150
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
18.20
|
08/31/2006
|
01/01/2007
|
|
151
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
20.70
|
08/31/2006
|
01/01/2007
|
|
152
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
19.90
|
08/31/2006
|
01/01/2007
|
|
153
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
15.90
|
08/31/2006
|
01/01/2007
|
|
154
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
18.70
|
08/31/2006
|
01/01/2007
|
|
155
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
16.70
|
08/31/2006
|
01/01/2007
|
Page 6
of 9 - WELLCARE PRESCRIPTION INSURANCE,
INC. - S5967 - 09/05/2006
|
Plan
ID
|
Segment
ID
|
Version
|
Plan
Name
|
Plan
Type
|
Transaction
Type
|
Part
D Premium
|
CMS
Approval Date
|
Effective
Date
|
|
156
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
15.30
|
08/31/2006
|
01/01/2007
|
|
157
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
20.30
|
08/31/2006
|
01/01/2007
|
|
158
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
18.20
|
08/31/2006
|
01/01/2007
|
|
159
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
11.00
|
08/31/2006
|
01/01/2007
|
|
160
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
20.10
|
08/31/2006
|
01/01/2007
|
|
161
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
20.60
|
08/31/2006
|
01/01/2007
|
|
162
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
18.80
|
08/31/2006
|
01/01/2007
|
|
163
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
17.30
|
08/31/2006
|
01/01/2007
|
|
164
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
17.00
|
08/31/2006
|
01/01/2007
|
|
165
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
10.40
|
08/31/2006
|
01/01/2007
|
|
166
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
10.60
|
08/31/2006
|
01/01/2007
|
|
167
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
22.40
|
08/31/2006
|
01/01/2007
|
|
168
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
24.00
|
08/31/2006
|
01/01/2007
|
|
169
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
9.70
|
08/31/2006
|
01/01/2007
|
|
170
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
17.30
|
08/31/2006
|
01/01/2007
|
Page 7
of 9 - WELLCARE PRESCRIPTION INSURANCE,
INC. - S5967 - 09/05/2006
|
Plan
ID
|
Segment
ID
|
Version
|
Plan
Name
|
Plan
Type
|
Transaction
Type
|
Part
D Premium
|
CMS
Approval Date
|
Effective
Date
|
|
171
|
0
|
2
|
WellCare
Classic
|
Medicare
Prescription Drug Plan
|
Renewal
|
29.40
|
08/31/2006
|
01/01/2007
|
|
801
|
0
|
1
|
WellCare
Smart Plan
|
Medicare
Prescription Drug Plan
|
Renewal
|
35.10
|
08/31/2006
|
01/01/2007
|
|
802
|
0
|
1
|
WellCare
Smart Plan
|
Medicare
Prescription Drug Plan
|
Renewal
|
35.10
|
08/31/2006
|
01/01/2007
|
Page 8 of 9 - WELLCARE PRESCRIPTION INSURANCE, INC. - S5967 - 09/05/2006
*
For all
800-series Plan IDs, plans have the flexibility to vary the premium amounts
that
they charge. Therefore, the amount listed in the "Part D Premium" column
may not
coincide with the amount actually charged. For CY2007, the direct subsidy
payment will be based on the national average monthly bid amount rather than
on
the bid submitted by the plan. Also, the base beneficiary premium will be
used
rather than the plan's premium as derived from their standardized bid in
determining the low-income premium subsidy.
|
/s/
Xxxx Xxxxx
CEO:
Xxxx
Xxxxx
CEO/President
0000
Xxxxxxxxx Xxxx, Xxx 0
Xxxxx,
XX 00000
|
9/6/06
Date
|
|
/s/
Xxxx Xxxxxxx
CFO
Xxxx
Xxxxxxx
Chief
Financial Officer
0000
Xxxxxxxxx Xxxx, Xxx 0
Xxxxx,
XX 00000
888-888-9355
(1469)
|
9/6/06
Date
|
Page
9 of
9 - WELLCARE PRESCRIPTION INSURANCE, INC. - S5967 -
09/05/2006
