Exhibit 10.49.1
(STATE OF NEW YORK DEPARTMENT OF HEALTH LOGO)
CORNING TOWER THE GOVERNOR NELSON A. ROCKEFELLER EMPIRE STATE PLAZA ALBANY, NEW
YORK 12237
ANTONIA C. NOVELLO, M.D., M.P.H., DR.P.H. DENNIS P. WHALEN
COMMISSIONER EXECUTIVE DEPUTY COMMISSIONER
DATE: Aug. 30, 2005
CONTRACT #: C015473
CONTRACTOR: CAREPLUS HEALTH PLAN
CONTRACT PERIOD: Jan. 01, 2005 - Dec. 31, 2005
Attached is your copy of the approved contract. The Contract number
must appear on all vouchers and correspondence.
Reports of the Expenditures and Budget Statements should be submitted
as outlined in the Contract.
In accordance with the contract, properly completed vouchers and/or
programmatic questions should be addressed to the State's designated
payment office as stated in the Contract.
Failure of the contracting Agency to comply with payment provisions as
set forth in the approved Contract may result in non-payment.
An additional supply of vouchers to be used in submitting claims may
be obtained by written request from the Office of the State Comptroller,
Supply Room, 110 State Street, 2nd Floor, Albany, New York 12236.
New York State Department of Health
Contract Unit
Page 2
Please note the following new information regarding payments:
OSC now offers Electronic Payments. Payments formerly made by check
can be made by electronic funds transfer through the Automated
Clearinghouse (ACH) network, and with OSC optional e-mail notification
service, you will receive advance notice of your electronic payments.
Additional information is available on-line at
HTTP://WWW.OSC.STATE.NY.US/EPAY/HOW.HTM or by calling 518-474-4032.
APPENDIX X
AGENCY CODE: 12000 CONTRACT NO.: C-015473
PERIOD: JULY 1, 1998 - FUNDING AMOUNT FOR PERIOD: $214,906,633
DECEMBER 31, 2005
This is an AGREEMENT between THE STATE OF NEW YORK, acting by and through the
Department of Health, having its principal office at Corning Tower, Empire State
Plaza, Albany, NY, (hereinafter referred to as the STATE), and CARE PLUS HEALTH
PLAN hereinafter referred to as the CONTRACTOR), for modification of Contract
Number C-015473 as reflected in the attached provisions to Section I.B.1. of the
Agreement and Appendices E and L,, and to extend the period of the contract
through December 31, 2005.
All other provisions of said AGREEMENT shall remain in full force and effect.
IN WITNESS WHEREOF, the parties hereto have executed this AGREEMENT as of the
dates appearing under their signatures.
CONTRACTOR SIGNATURE STATE AGENCY SIGNATURE
By: /s/ Nasry Michelen By: /s/ Judith Arnold
--------------------------------- ------------------------------------
Nasry Michelen Judith Arnold
Printed Name Printed Name
Title: Chief Executive Officer Title: Deputy Commissioner
Division of Planning, Policy,
& Resource Development
Date: 6/20/05 Date: 7/6/05
State Agency Certification:
"In addition to the acceptance of this
contract, I also certify that original
copies of this signature page will be
attached to all other exact copies of
this contract."
STATE OF NEW YORK )SS.:
)
Country of New York )
On the 20th day of June 2005, before me personally appeared Yosry Michelen, to
me known, who being by me duly sworn, did depose and say that he/she resides at
360 west 31st. NY, NY 10001 that he/she is the Chief Executive Office of the
Core Plus Health Plus the corporation described herein which executed the
foregoing instrument; and that he/she signed his/her name thereto by order of
the board of directors of said corporation.
(Notary)
/s/ Gerard Harrington
- -------------------------------------
GERARD HARRINGTON
Notary Public, State of New York
No. 01HA6102369
Qualified in New York County
Commission Expires Dec. 8, 2007
STATE COMPTROLLER SIGNATURE
/s/ Charlotte (?????)
- ------------------------------------- Title:
---------------------------------
Date: 8/22/05
---------------------
APPROVED AS TO FORM
NYS ATTORNEY GENERAL
AUG 02 2005
/s/ STEPHEN J. HENSEL
---------------------
STEPHEN J. HENSEL
ASSOCIATE ATTORNEY
---------------------
STATE OF NEW YORK
AGREEMENT
Section I.B.1. is revised to read as follows:
I. Conditions of Agreement
B.1. This AGREEMENT is extended through December 31, 2005.
APPENDIX E
FINANCIAL INFORMATION
Section A is revised to read as follows:
A. Care Plus Health Plan shall receive, for the period July 1, 2005 through
December 31, 2005, an amount up to, but not to exceed, $16,300,000 to provide
and administer a Child Health Plus program for uninsured children in the
counties identified in Appendix A-2, Section II.B.1 of this AGREEMENT or as
modified by the STATE. Payment of this amount is based on the CONTRACTOR meeting
the responsibilities provided in this AGREEMENT.
Additional Premium Information:
For Kings, New York, Queens and Richmond county(ies):
The total monthly premium shall be: $110.70
The State share of the total monthly premium shall be $110.70 or the total
monthly premium for children in families with gross household income less
than 160% of the federal poverty level and children who are American
Indians or Alaskan Natives (AI/AN).
The State share of the total monthly premium shall be $101.70 or the total
monthly premium minus $9 for children in families with gross household
income between 160% and 222% of the federal poverty level with a maximum of
$27 per month per family. The State share is the total monthly premium less
$9 for each of the first three children. For additional children, the State
share is the total monthly premium.
The State share of the total monthly premium shall be $95.70 or the total
monthly premium minus $15 for children in families with gross household
income between 223% and 250% of the federal poverty level with a maximum of
$45 per month per family. The State share is the total monthly premium less
$15 for each of the first three children. For additional children, the
State share is the total monthly premium.
In the absence of an approved premium modification by the Department of
Health and State Insurance Department, the premium above or subsequent premium
approved (whichever is in effect) shall continue as the State's subsidy through
December 31, 2005.
APPENDIX L
PRIVACY AND CONFIDENTIALITY
Section II is revised as follows:
II. Effective April 14, 2003, the CONTRACTOR shall comply with the
following agreement:
Federal Health Insurance Portability and Accountability Act (HIPAA)
Business Associate Agreement ("Agreement")
This Business Associate Agreement between the New York State Department of
Health and Care Plus Health Plan, hereinafter referred to as the Business
Associate, is effective on April 14, 2003 to December 31, 2005.