Common use of Incorporation of Applicable Addenda Clause in Contracts

Incorporation of Applicable Addenda. All addenda checked off and initialed on the cover sheet of this contract by the MA Organization are hereby incorporated by reference. In witness whereof, the parties hereby execute this contract. FOR THE MA ORGANIZATION Xxxx X. Xxxxx President & Chief Executive Officer Printed Name Title /s/ Xxxx X. Xxxxx 9-7-05 Signature Date WellCare of Connecticut, Inc. 0000 Xxxxxxxxx Xxxx, Ren. 2 Tampa, FL 33634 Organization Address FOR THE CENTERS FOR MEDICARE & MEDICAID SERVICES /s/ Xxxxx Xxxxx for 9/30/05 Xxxxxxxx X. Xxxxx Date Director Medicare Advantage Group Center for Beneficiary Choices ATTACHMENT A ATTESTATION OF ENROLLMENT INFORMATION RELATING TO CMS PAYMENT TO A MEDICARE ADVANTAGE ORGANIZATION Pursuant to the contract(s) between the Centers for Medicare & Medicaid Services (CMS) and (INSERT NAME OF MA ORGANIZATION), hereafter referred to as the MA Organization, governing the operation of the following Medicare Advantage plans (INSERT PLAN IDENTIFICATION NUMBERS HERE), the MA Organization hereby requests payment under the contract, and in doing so, makes the following attestation concerning CMS payments to the MA Organization. The MA Organization acknowledges that the information described below directly affects the calculation of CMS payments to the MA Organization and that misrepresentations to CMS about the accuracy of such information may result in Federal civil action and/or criminal prosecution. This attestation shall not be considered a waiver of the MA Organization’s right to seek payment adjustments from CMS based on information or data which does not become available until after the date the MA Organization submits this attestation.

Incorporation of Applicable Addenda. All addenda checked off and initialed on the cover sheet of this contract by the MA Organization are hereby incorporated by reference. In witness whereof, the parties hereby execute this contract. FOR THE MA ORGANIZATION Xxxx X. Xxxxx President & Chief Executive Officer Printed Name President and CEO Title /s/ Xxxx X. Xxxxx 9-7-05 Signature 9/14/06 Date WellCare of Connecticut, Inc. Stone Harbor Ins. Co. Organization 0000 Xxxxxxxxx Xxxx, Ren. 2 TampaXx Xxxxx, FL 33634 Organization Address FOR THE CENTERS FOR MEDICARE & MEDICAID SERVICES /s/ Xxxxx Xxxxx for 9/30/05 Xxxxxxxx Xxxxx X. Xxxxx Date Acting Director Medicare Advantage Group Center for Beneficiary Choices 9/29/06 Date ATTACHMENT A ATTESTATION OF ENROLLMENT INFORMATION RELATING TO CMS PAYMENT TO A MEDICARE ADVANTAGE ORGANIZATION Pursuant to the contract(s) between the Centers for Medicare & Medicaid Services (CMS) and (INSERT NAME OF MA ORGANIZATION), hereafter referred to as the MA Organization, governing the operation of the following Medicare Advantage plans (INSERT PLAN IDENTIFICATION NUMBERS HERE), the MA Organization hereby requests payment under the contract, and in doing so, makes the following attestation concerning CMS payments to the MA Organization. The MA Organization acknowledges that the information described below directly affects the calculation of CMS payments to the MA Organization and that misrepresentations to CMS about the accuracy of such information may result in Federal civil action and/or criminal prosecution. This attestation shall not be considered a waiver of the MA Organization’s 's right to seek payment adjustments from CMS based on information or data which does not become available until after the date the MA Organization submits this attestation.

Incorporation of Applicable Addenda. All addenda checked off and initialed on the cover sheet of this contract by the MA Organization are hereby incorporated by reference. In witness whereof, the parties hereby execute this contract. FOR THE MA ORGANIZATION Xxxx Txxx X. Xxxxx President & Chief Executive Officer Printed Name President and CEO Title /s/ Xxxx Txxx X. Xxxxx 9-7-05 Signature 9/14/06 Date WellCare of ConnecticutAdvance /WellCare PFFS Insurance, Inc. 0000 Organization 8000 Xxxxxxxxx Xxxx, Ren. 2 TampaXx Xxxxx, FL 33634 Organization Address FOR THE CENTERS FOR MEDICARE & MEDICAID SERVICES /s/ Dxxxx Xxxxx Xxxxx for 9/30/05 Xxxxxxxx Dxxxx X. Xxxxx Date Acting Director Medicare Advantage Group Center for Beneficiary Choices 9/25/06 Date ATTACHMENT A ATTESTATION OF ENROLLMENT INFORMATION RELATING TO CMS PAYMENT TO A MEDICARE ADVANTAGE ORGANIZATION Pursuant to the contract(s) between the Centers for Medicare & Medicaid Services (CMS) and (INSERT NAME OF MA ORGANIZATION), hereafter referred to as the MA Organization, governing the operation of the following Medicare Advantage plans (INSERT PLAN IDENTIFICATION NUMBERS HERE), the MA Organization hereby requests payment under the contract, and in doing so, makes the following attestation concerning CMS payments to the MA Organization. The MA Organization acknowledges that the information described below directly affects the calculation of CMS payments to the MA Organization and that misrepresentations to CMS about the accuracy of such information may result in Federal civil action and/or criminal prosecution. This attestation shall not be considered a waiver of the MA Organization’s 's right to seek payment adjustments from CMS based on information or data which does not become available until after the date the MA Organization submits this attestation.

Incorporation of Applicable Addenda. All addenda checked off and initialed on the cover sheet of this contract by the MA Organization are axe hereby incorporated by reference. In witness whereof, the parties hereby execute this contract. FOR THE MA ORGANIZATION Xxxx X. Xxxxx President & Chief Executive Officer Printed Name Title /s/ Xxxx X. Xxxxx 9-7-05 Signature Date WellCare of ConnecticutGeorgia, Inc. 0000 Xxxxxxxxx Xxxx, Ren. 2 Tampa, FL 33634 Organization Address FOR THE CENTERS FOR MEDICARE & MEDICAID SERVICES /s/ Xxxxx Xxxxx for 9/30/05 Xxxxxxxx X. Xxxxx Date Director Medicare Advantage Group Center for Beneficiary Choices 19 ATTACHMENT A ATTESTATION OF ENROLLMENT INFORMATION RELATING TO CMS PAYMENT TO A MEDICARE ADVANTAGE ORGANIZATION Pursuant to the contract(s) between the Centers for Medicare & Medicaid Services (CMS) and (INSERT NAME OF MA ORGANIZATION), hereafter referred to as the MA Organization, governing the operation of the following Medicare Advantage plans (INSERT PLAN IDENTIFICATION NUMBERS HERE), the MA Organization hereby requests payment under the contract, and in doing so, makes the following attestation concerning CMS payments to the MA Organization. The MA Organization acknowledges that the information described below directly affects the calculation of CMS payments to the MA Organization and that misrepresentations to CMS about the accuracy of such information may result in Federal civil action and/or criminal prosecution. This attestation shall not be considered a waiver of the MA Organization’s right to seek payment adjustments from CMS based on information or data which does not become available until after the date the MA Organization submits this attestation.

Incorporation of Applicable Addenda. All addenda checked off and initialed on the cover sheet of this contract by the MA Organization are hereby incorporated by reference. In witness whereof, the parties hereby execute this contract. FOR THE MA ORGANIZATION Xxxx X. Xxxxx President & Chief Executive Officer Printed Name President and CEO Title /s/ Xxxx X. Xxxxx 9-7-05 Signature 9/14/06 Date Homeowner’s/WellCare of ConnecticutPFFS Insurance, Inc. Organization 0000 Xxxxxxxxx Xxxx, Ren. 2 TampaXx Xxxxx, FL 33634 Organization Address FOR THE CENTERS FOR MEDICARE & MEDICAID SERVICES /s/ Xxxxx Xxxxx for 9/30/05 Xxxxxxxx Xxxxx X. Xxxxx Date Acting Director Medicare Advantage Group Center for Beneficiary Choices 9/25/06 Date ATTACHMENT A ATTESTATION OF ENROLLMENT INFORMATION RELATING TO CMS PAYMENT TO A MEDICARE ADVANTAGE ORGANIZATION Pursuant to the contract(s) between the Centers for Medicare & Medicaid Services (CMS) and (INSERT NAME OF MA ORGANIZATION), hereafter referred to as the MA Organization, governing the operation of the following Medicare Advantage plans (INSERT PLAN IDENTIFICATION NUMBERS HERE), the MA Organization hereby requests payment under the contract, and in doing so, makes the following attestation concerning CMS payments to the MA Organization. The MA Organization acknowledges that the information described below directly affects the calculation of CMS payments to the MA Organization and that misrepresentations to CMS about the accuracy of such information may result in Federal civil action and/or criminal prosecution. This attestation shall not be considered a waiver of the MA Organization’s 's right to seek payment adjustments from CMS based on information or data which does not become available until after the date the MA Organization submits this attestation.

Incorporation of Applicable Addenda. All addenda checked off and initialed on the cover sheet of this contract by the MA Organization are hereby incorporated by reference. In witness whereof, the parties hereby execute this contract. FOR THE MA ORGANIZATION Xxxx X. Xxxxx President & Chief Executive Officer Printed Name Title /s/ Xxxx X. Xxxxx 9-7-05 Signature Date WellCare of ConnecticutNew York, Inc. 0000 Xxxxxxxxx Xxxx, Ren. 2 Tampa, FL 33634 Organization Address FOR THE CENTERS FOR MEDICARE & MEDICAID SERVICES /s/ Xxxxx Xxxxx for 9/30/05 10/06/05 Xxxxxxxx X. Xxxxx Date Director Medicare Advantage Group Center for Beneficiary Choices 19 ATTACHMENT A ATTESTATION OF ENROLLMENT INFORMATION RELATING TO CMS PAYMENT TO A MEDICARE ADVANTAGE ORGANIZATION Pursuant to the contract(s) between the Centers for Medicare & Medicaid Services (CMS) and (INSERT NAME OF MA ORGANIZATION), hereafter referred to as the MA Organization, governing the operation of the following Medicare Advantage plans (INSERT PLAN IDENTIFICATION NUMBERS HERE), the MA Organization hereby requests payment under the contract, and in doing so, makes the following attestation concerning CMS payments to the MA Organization. The MA Organization acknowledges that the information described below directly affects the calculation of CMS payments to the MA Organization and that misrepresentations to CMS about the accuracy of such information may result in Federal civil action and/or criminal prosecution. This attestation shall not be considered a waiver of the MA Organization’s right to seek payment adjustments from CMS based on information or data which does not become available until after the date the MA Organization submits this attestation.

Incorporation of Applicable Addenda. All addenda checked off and initialed on the cover sheet of this tins contract by the MA Organization are hereby incorporated by reference. In witness whereof, the parties hereby execute this contract. FOR THE MA ORGANIZATION Xxxx X. Xxxxx President & Chief Executive Officer Xxxxxxxxx Printed Name President and CEO Title /s/ Xxxx X. Xxxxx 9-7-05 Xxxxxxxxx Signature 9/5/08 Date WellCare Health Insurance of ConnecticutArizona, Inc. Organization 0000 Xxxxxxxxx XxxxXx, Ren. 2 Tampa, FL 33634 Organization Address FOR THE CENTERS FOR MEDICARE & MEDICAID SERVICES /s/ Xxxxx Xxxxx for 9/30/05 Xxxxxxxx X. Xxxxx Date Xxxxxx XxXxxx Xxxxxx XxXxxx R.N., MS Acting Director Medicare Advantage Drug and Health Plan Contract Administration Group Center for Beneficiary Choices Drug and Health Plan Choice 11/18/08 Date ATTACHMENT A ATTESTATION OF ENROLLMENT INFORMATION RELATING TO CMS PAYMENT TO A MEDICARE ADVANTAGE ORGANIZATION Pursuant to the contract(scontractus) between the Centers for Medicare & Medicaid Services (CMS) and (INSERT NAME OF MA ORGANIZATION), hereafter referred to as the MA Organization, governing the operation of the following Medicare Advantage plans (INSERT PLAN IDENTIFICATION NUMBERS HERE), the MA Organization hereby requests payment under the contract, and in doing so, makes the following attestation concerning CMS payments to the MA Organization. The MA Organization acknowledges that the information described below directly affects the calculation of CMS payments to the MA Organization and that misrepresentations to CMS about the accuracy of such information may result in Federal civil action and/or criminal prosecution. This attestation shall not be considered a waiver of the MA Organization’s 's right to seek payment adjustments from CMS based on information or data which does not become available until after the date the MA Organization submits this attestation.

Incorporation of Applicable Addenda. All addenda checked off and initialed on the cover sheet of this contract by the MA Organization are hereby incorporated by reference. In witness whereof, the parties hereby execute this contract. FOR THE MA ORGANIZATION Xxxx X. Xxxxx President & Chief Executive Officer Printed Name Title /s/ Xxxx X. Xxxxx 9-7-05 Signature Date WellCare of ConnecticutLouisiana, Inc. 0000 Xxxxxxxxx Xxxx, Ren. 2 Tampa, FL 33634 Organization Address FOR THE CENTERS FOR MEDICARE & MEDICAID SERVICES /s/ Xxxxx Xxxxx for 9/30/05 10/03/05 Xxxxxxxx X. Xxxxx Date Director Medicare Advantage Group Center for Beneficiary Choices 19 ATTACHMENT A ATTESTATION OF ENROLLMENT INFORMATION RELATING TO CMS PAYMENT TO A MEDICARE ADVANTAGE ORGANIZATION Pursuant to the contract(s) between the Centers for Medicare & Medicaid Services (CMS) and (INSERT NAME OF MA ORGANIZATION), hereafter referred to as the MA Organization, governing the operation of the following Medicare Advantage plans (INSERT PLAN IDENTIFICATION NUMBERS HERE), the MA Organization hereby requests payment under the contract, and in doing so, makes the following attestation concerning CMS payments to the MA Organization. The MA Organization acknowledges that the information described below directly affects the calculation of CMS payments to the MA Organization and that misrepresentations to CMS about the accuracy of such information may result in Federal civil action and/or criminal prosecution. This attestation shall not be considered a waiver of the MA Organization’s right to seek payment adjustments from CMS based on information or data which does not become available until after the date the MA Organization submits this attestation.

Incorporation of Applicable Addenda. All addenda checked off and initialed on the cover sheet of this contract by the MA Organization are hereby incorporated by reference. In witness whereof, the parties hereby execute this contract. FOR THE MA ORGANIZATION Xxxx X. Xxxxx President & Chief Executive Officer Printed Name Title /s/ Xxxx X. Xxxxx 9-7-05 Signature Date WellCare Harmony Health Plan of ConnecticutIllinois, Inc. 0000 Xxxxxxxxx Xxxx, Ren. 2 Tampa, FL 33634 Organization Address FOR THE CENTERS FOR MEDICARE & MEDICAID SERVICES /s/ Xxxxx Xxxxx for 9/30/05 Xxxxxxxx X. Xxxxx Date Director Medicare Advantage Group Center for Beneficiary Choices ATTACHMENT A ATTESTATION OF ENROLLMENT INFORMATION RELATING TO CMS PAYMENT TO A MEDICARE ADVANTAGE ORGANIZATION Pursuant to the contract(s) between the Centers for Medicare & Medicaid Services (CMS) and (INSERT NAME OF MA ORGANIZATION), hereafter referred to as the MA Organization, governing the operation of the following Medicare Advantage plans (INSERT PLAN IDENTIFICATION NUMBERS HERE), the MA Organization hereby requests payment under the contract, and in doing so, makes the following attestation concerning CMS payments to the MA Organization. The MA Organization acknowledges that the information described below directly affects the calculation of CMS payments to the MA Organization and that misrepresentations to CMS about the accuracy of such information may result in Federal civil action and/or criminal prosecution. This attestation shall not be considered a waiver of the MA Organization’s right to seek payment adjustments from CMS based on information or data which does not become available until after the date the MA Organization submits this attestation.

Incorporation of Applicable Addenda. All addenda checked off and initialed on the cover sheet of this contract by the MA Organization are hereby incorporated by reference. In witness whereof, the parties hereby execute this contract. FOR THE MA ORGANIZATION Xxxx X. Xxxxx President & Chief Executive Officer Printed Name Title /s/ Xxxx X. Xxxxx 9-7-05 Signature Date WellCare of ConnecticutFlorida, Inc. 0000 Xxxxxxxxx Xxxx, Ren. 2 Tampa, FL 33634 Organization Address FOR THE CENTERS FOR MEDICARE & MEDICAID SERVICES /s/ Xxxxx Xxxxx for 9/30/05 Xxxxxxxx X. Xxxxx Date Director Medicare Advantage Group Center for Beneficiary Choices 19 ATTACHMENT A ATTESTATION OF ENROLLMENT INFORMATION RELATING TO CMS PAYMENT TO A MEDICARE ADVANTAGE ORGANIZATION Pursuant to the contract(s) between the Centers for Medicare & Medicaid Services (CMS) and (INSERT NAME OF MA ORGANIZATION), hereafter referred to as the MA Organization, governing the operation of the following Medicare Advantage plans (INSERT PLAN IDENTIFICATION NUMBERS HERE), the MA Organization hereby requests payment under the contract, and in doing so, makes the following attestation concerning CMS payments to the MA Organization. The MA Organization acknowledges that the information described below directly affects the calculation of CMS payments to the MA Organization and that misrepresentations to CMS about the accuracy of such information may result in Federal civil action and/or criminal prosecution. This attestation shall not be considered a waiver of the MA Organization’s right to seek payment adjustments from CMS based on information or data which does not become available until after the date the MA Organization submits this attestation.